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Hospice Care
Hospice care eases the way

They have been our loyal companions throughout their lives, and in hospice, they need to know that we will dance to the end of the song with them.
—Thomas F. Wilson, PhD

When our dogs are young and healthy, it seems as though we have all the time in the world with them. But, as it always does, time catches up with us, and eventually, the “end of the song” begins to play. For many of us, our companion animals are so integral to our lives that their decline and death affect us similarly to the loss of human family members.

However, the heart-wrenching words “Nothing else can be done” do not mean that euthanasia is the only option. As they move into the closing stages of their lives, pets (we’ll focus on dogs here, but the concept is the same for other companion animals) can benefit from animal hospice, and so can their people.

Like the program for humans, animal hospice exists to provide support and care during the last phase of an incurable disease or at the natural end of life; its primary goal is to manage pain. As such, hospice care is geared toward maintaining comfort and ensuring the highest quality of life possible during a time that may be measured in months, weeks or days. It focuses on creating a safe, loving and intimate endof- life experience in a familiar setting. This approach also gives us time to plan, grieve and say good-bye to our dogs. And—perhaps most importantly —it is a way to allow our best friends to spend their final days at home rather than in a hospital setting. This interval can be invaluable, as it helps us come to grips with our dog’s condition, and to say good-bye in our own way.

Though it can be extremely rewarding, hospice care does require preparation and effort. The first step is to connect with a veterinarian who is comfortable with the concept (not all are).

He or she will guide you in how to best provide for your dog’s needs, and in setting up a care plan to carry out at home: administering medications, supplying nutritional support, recognizing pain, implementing proper nursing care and tuning into your dog’s general emotional and physical state. If you are unsure about taking on these kinds of responsibilities, you may be able to employ a vet technician to assist you as needed.

As mentioned, one of the most important aspects of hospice care is pain management. Because it is easier to prevent pain than to relieve it, a multimodal approach—in which a variety of methods, including various classes of pain medications, natural supplements, acupuncture and massage therapy, to name a few, are employed—usually results in the best control. Part of this protocol involves monitoring your dog’s behavior and physical state, since agitation and vocalization may be signs of pain. In providing hospice care, you are the eyes and ears of the veterinary team, recording changes in your dog’s weight, temperature, eating habits, mobility and other characteristics and reporting them to the vet so that interventions or adjustments to the care plan can be made in a timely manner.

When it comes to end-of-life matters, we are faced with the difficult decision of allowing for a natural death or intervening with humane euthanasia; for some, a natural death is preferable to euthanasia as long as no suffering is involved. The decision if and when to euthanize is as individual and personal as you and your dog, and it’s important to keep in mind that no one knows your dog better than you do. You have spent your dog’s lifetime learning to communicate by reading body language and developing a unique bond. Attend to what your dog may be trying to tell you and, above all, trust your heart.

Identifying the point at which your dog’s quality of life has irrevocably ebbed requires personal courage and sacrifice, and many people fear they will not be able to recognize when the time is right. Seek guidance in the decision- making process from family members and friends, as well as from your veterinarian, all of whom share a bond with your dog. You will need the support of those who truly understand.

After months (or more) of caring for a dog in declining health, it can often be difficult to decide when the end has come, which is why it is helpful to determine ahead of time at what point you feel your dog’s quality of life is no longer acceptable. This may be when he or she ceases to find joy in eating, no longer enjoys interaction and connection, can no longer stand or walk, or when pain begins to be difficult to control. It is often helpful to consider good days versus bad days; more bad days than good is another indicator that the time is near. By establishing these criteria in advance, you are better prepared to make the appropriate decision, since emotion can cloud your thinking during the difficult final days of your dog’s life.

Hospice can be a wonderful, caring option. Regardless of how you choose to navigate this stage, it is good to know that it exists. Whether we opt for a natural death or a peaceful euthanasia, hospice care not only allows our dogs to live out the remainder of their lives as fully as possible, it also allows them to embark upon their final journey with dignity while surrounded by love in the comfort of their familiar home environment. Hospice care is truly a gift, both to our dogs and to ourselves.

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This article first appeared in The Bark,
Issue 73: Spring 2013

Veterinarian Shea Cox has enjoyed an indirect path through her professional life, initially obtaining degrees in fine arts and nursing. She later obtained her veterinary medical degree from Michigan State University in 2001 and has been practicing emergency and critical care medicine solely since that time. In 2006, she joined the ER staff at PETS Referral Center in Berkeley and cannot imagine a more rewarding and fulfilling place to spend her working hours. In her spare time, she loves to paint, wield her green thumb, cook up a storm and sail. Her days are shared with the three loves of her life: her husband Scott and their two Doberman children that curiously occupy opposite ends of the personality spectrum.

Illustration by Jon Krause

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Submitted by Clara Elton Sharp | February 8 2013 |

I have been an RN for almost 50 years, longer than hospice has existed in the USA.
I am now working part time with a local hospice agency, and have several years hospice experience.
My dream last job is to be a pet hospice nurse. However, i am not aware of a local pet hospice.
If any veterinarian in the NW suburbs of Atlanta, GA, offers hospice service, or is interested in starting, I would like some information as to how I can get involved.
This is the work I have in my heart.
Thank you for any information.
Clara

Submitted by Shea Cox DVM | February 12 2013 |

Hi Clara~ I don't know of any pet hospice practitioners personally in the Atlanta area, but a first place to start may be with the In Home Pet Euthanasia Directory (http://www.inhomepeteuthanasia.com) and "click" on your state. It will list those veterinarians who perform in-home euthanasia, and they may also offer hospice care as well. I hope this helps and good luck! ~ Shea

Submitted by Miss Jan | February 17 2013 |

I appreciated Dr. Cox' article in the (just now received, eagerly read) current Bark issue. May I suggest further considerations for hospice based on my personal experience with providing hospice care to my forever horse lost to cancer in 2004 and to my 16-year-old Jack Russell, lost to cancer in 2010?

First - with due respect to Dr. Cox, not all veterinarians are on board with hospice care and some are so adamantly opposed to it that they will actually threaten the animal guardian with attention from the authorities for "cruelty." It is vital to have a pro-hospice care veterinarian be part of your team and it is much easier to find such a veterinarian among the holistic/complementary care ranks of DVMs.

Second, assuming you have a veterinarian open to hospice, you need to learn from your veterinarian and from self-educating what the end of life stages are. This information is readily provided to caregivers in human hospice care. You really have to dig for it in animal hospice care.

Third and finally: Dr. Cox is mostly right in opining that hospice is rewarding but I would like to add this caveat: being thankful you did it and understanding the rewards from having done so often comes long after your beloved pet's passing. At the time, you will sometimes feel it is the hardest thing you have ever done in your life. I did it - twice, once with my heart horse and once with my forever Best.Dog.Ever, and I do not regret having provided hospice to these two wonderful souls, one old and one not so on in years. But the emotional roller coaster especially when the animal rallies briefly and you are climbing the sky emotionally because today's acupuncture treatment was startlingly effective - only to crash when the effects wear off in less than 24 hours - that is really, really hard. And, although at some level you are more prepared for a passing and committed to the path chosen for your dog's end of life (and yes, they do "tell you" when it's time and sometimes once you let them know it's okay to leave you and cross the rainbow bridge, they will choose to do that on their own without awaiting the blessed needle), you just do not cry any less. And it is sometimes quite a while before you are able to remind yourself, I am glad I did what I did for my dog.

Submitted by clara sharp | August 9 2013 |

Miss Jan, you have the heart of an angel. You are exactly right, about the difficulty giving your pets hospice care. and, while helping others during their passing can be healing, you must give your own soul time to recover, (not at all 'getting over')
I am a hospice nurse for humans, and I would love my last job to be in pet hospice. But, the concept is new and most vets do most of the work themselves. Understandably.
Two of my dogs, both seniors, are therapy pets, who visit hospice patients. When you have a new pet, you might consider having him/her certified. It is not limited to dogs, but cats, horses, birds, can all be trained as therapy pets.
Keeping you in my prayers, and wishing you the best.

Submitted by Katherine Goldb... | February 28 2013 |

Thank you, Bark, for your attention to veterinary hospice care. It is my sincerest hope that your readership & staff will be inspired to support comprehensive end of life care for their beloved pets, and spread the word. Please let me know if there is anything I can do to help with community outreach or additional coverage in this regard.
With gratitude,
Katherine Goldberg, DVM
Whole Animal Veterinary Hospice Services
Ithaca, NY
www.wholeanimalvet.com
Board member, International Association for Animal Hospice & Palliative Care

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