The human-animal bond is a celebrated and cherished one. This bond grows even stronger during an animal’s end-of-life journey. When pets enter their final decline, often involving cancer, owners usually feel strong emotions and may suffer anticipatory grief. They want to spend as much time with their pets as possible. Integrative care can improve the quality of life for terminal patients, and reassure their owners that they’re doing a good job helping their animals through their last days.
At our practice, clients don’t expect us to recommend euthanasia without first perusing reasonable supportive and palliative care options. They seem to be pleased when we tell them we provide integrative care. While many practices still use the “either/or” system of recommending euthanasia versus potentially expensive treatments for cancer patients, many are now offering veterinary hospice (“Pawspice”) as a third option.
A major difference between human and animal hospice is that we can begin to offer pets hospice care upon diagnosis, rather than merely when they’re near death. Animal hospice provides an alternative to further aggressive treatment when rounds one or two have failed. We can propose compassionate at-home palliative care to meet the special needs of end-of-life patients. A well-conceptualized integrative palliative plan may be the very best medicine we can offer a terminal patient in support of the human-animal bond.
QUALITY OF LIFE
When is an animal suffering too much? How best can this be judged? I use a Quality of Life Scale that incorporates seven important criteria (with the acronym “HHHHHMM”) to make it easy to remember a pet’s needs and desires.
We feel every Pawspice program should strive to monitor the following: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad days. Clients, technicians and veterinarians can assess the patient daily using a 0 (worst) to 10 (best) scale. Scores above 5 on most criteria are acceptable for maintaining a pet in hospice.
Each animal’s situation needs to be customized, and each pet owner needs to be recognized as an individual who requires kind, supportive coaching to come to terms with the decision to end a best friend’s life. The HHHHHMM Quality of Life Scale can be downloaded at pawspice.com.
IMMUNONUTRITION AND CHEMOPREVENTION – NUTRITION AND NUTRACEUTICALS
According to Dr. Philip Bergman, when he was at M.D. Anderson Memorial Cancer Center, chemoprevention involves the use of natural or synthetic compounds that may reverse or suppress the process of carcinogenesis, metastasis and recurrence. Nutritional advice and a nutraceutical supplementation program that underscores cancer prevention for treated, untreated or terminally ill companion animals may be professionally and sensibly supervised at your veterinary facility. This service creates further client confidence that the primary care veterinarian is helping address the pet’s immune system and organ function as much as possible.
Some natural supplements or nutraceuticals have been shown to reduce cancer risk by playing a role in the cell cycle. I call these natural compounds “foodiceuticals” to emphasize to clients that they are generally non-toxic and found in nature.1,2
• Inositol hexaphosphate (IP-6), derived from soybeans, rice, sesame seeds, beans, legumes and cereals, is an anti-carcinogenic. It has potent antioxidant action and enhances natural killer-cell activity.3
• Agaricus Bio contains beta glucans derived from the Agaricus blazei mushroom; these stimulate macrophage activity and increase natural killer cells to destroy viral, bacterial and malignant cells. It is used for the prevention of a wide range of chronic conditions.4
• Advanced Protection Formula (APF) Drops with Siberian ginseng enhance adaptogen activity, help with energy and appetite, and may stabilize diabetic pets.5
• Hepato Support contains milk thistle (silymarin), B vitamins and alpha lipoic acid to help liver function and increase glutathione levels up to 35%, protecting the liver and helping it detoxify chemotherapy drugs.6
• Platinum Performance is a comprehensive and beneficial blend of vitamins, minerals and supplements that I favor for my cancer patients. Some dogs may develop soft stools or diarrhea due to the Omega-3 fatty acids, so we introduce it to the diet gradually.7
• Standard Process has a line of excellent products that support various organ functions. I use K-9 Musculoskeletal Support for many of my frail patients.8
• Onco Support contains Hepato Support, botanicals, probiotics and ginger that help the immune system and the GI tract during the stress of chronic disease and neoplasia.9
• Primal Dose is bovine colostrum that nourishes the immune function of dogs and cats with chronic disease and cachexia. Cats like it and it is great for pets on feeding tubes.10
• Diet may be a prescription food, a high quality life stage diet, or a home-prepared grain-free diet high in protein and fatty acids and low in carbohydrates and sugars.
SUPPORTING THE EMOTIONAL NEEDS OF CLIENTS
Based upon personality, marital/family situations, and other life issues, pet owners may respond with a wide range of emotions, from panic to shutdown, when faced with a terminal illness in their animals. We must always speak kindly and respectfully to support the emotional needs of clients who choose to journey to the end with their beloved pets. Many pet owners are so upset and worried about the future that they miss out on today’s enjoyment with their animals. Not recognizing anticipatory grief, a distraught pet owner can even lessen the quality of her pet’s remaining life.
In Pawspice, we can help clients realize that at the present, their pets are still very much alive. We must try to uplift and guide sad or depressed clients, help them value the good parts of each day, and encourage them to interact and communicate with their pets during private moments. Referring clients for pet loss counseling at the Association of Pet Loss and Bereavement (aplb.org) can not only help clients, but also retain balance for the clinician.
During your patients’ lives, their owners become bonded to you and your staff, and to visiting your facility and interacting with you. This social contact ends with a pet’s passing. So for a client, hospice is more than a farewell for a beloved animal; it is also a parting of connections and supportive relationships with you and your staff. In addition, when the enormous burden of caring for a dying pet comes to an end, clients may experience a sense of relief that then makes them feel guilty or remorseful. With a hospice program, you can help ameliorate these feelings.11
KEY POINTS FOR A SUCCESSFUL HOSPICE PRACTICE
Increasing your communication skills and paying attention to your clients’ values, keeping your patients’ best interests in mind, and practicing everyday ethics and care are the mainstay keys to a successful hospice practice.
• You can help increase client compliance by making your records more transparent; give a copy of your medical notes to the client at each visit, along with the patient’s Quality of Life Scale Score and recommendations on how to improve certain criteria.
• Help clients access pet comfort aids such as ramps, lift harnesses, or proper bedding from reliable sources.
• Show clients how to keep their pets clean and odor-free.
• Give them handouts and website access information from VIN (veterinarypartners.com).
• Introduce clients to others with similar problems so they can network. Help them find case-similar chat rooms and guide them to the Association for Pet Loss and Bereavement.
• Help clients plan for their pets’ afterlife needs with referrals to trusted pet cremation facilities, and/or cemeteries where viewing and memorial services can be held. Clients appreciate having a like-minded community!
For the technical and logistical requirements needed to establish a pet hospice practice, there are plenty of readily-accessed reading materials and webinars available from members of the International Association of Animal Hospice and Palliative Care (iaahpc.org). One article in particular – “Establishing a Hospice and Palliative Care Practice”, by Yazley in the 2013 IAAHPC Proceedings – describes key points in detail.12
Animal hospice is a rewarding and enriching experience, not just for your clients and their pets, but for you and your practice as well.
1 Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond, 2007, Wiley.com
9 Robert Silver, DVM, formulator for Rx Vitamins for pets
11 ”Relief is a Natural Part of Grief”, Veterinary Practice News, columns by Dr. Villalobos