What Is Pet Hospice?

By Dr. Kristi Freeman

One of the most difficult decisions a pet owner faces is when their beloved pet has been diagnosed with a terminal disease or has a poor chance of survival due to age, injury or other factors. What if you are not ready to make the decision of euthanasia or you feel strongly that euthanasia is not an option?

Today, there is a relatively new option called Pet Hospice. This is a service where your pet, under the direction of a veterinarian, is allowed to live out his or her remaining days at home with as much dignity and comfort as possible. This involves at-home nursing care, pain management and bereavement planning.

In a hospice appointment, Dr. Freeman assists the caregiver with home visitations and prescribing medication to help control your pet's disease or any associated pain. How do we know when an animal is in pain? Assessing just how much pain can be difficult. Some of the signs of pain in dogs and cats include abnormal actions, such as:

• Posture–hunching, refusing to move or lie down, flinching, trembling.
• Movement–limping, circling, restless, pacing.
• Vocalizing–whining, crying, being too quiet or sometimes even purring.
• Losing house training.
• Licking a certain area excessively.
• Decreased appetite.
• Decreased grooming.
• Fast breathing.
• Dilated pupils.
• Aggression.

As a pet owner, you have a close relationship with your animal and are best one to note any change of behavior. Some animals will hide their pain very well and the presence of pain is realized only after medication is begun and the pet responds favorably. It is very important that you do not self-prescribe medications to your pet without first consulting your veterinarian. Some over-the-counter medications are toxic to pets. For example, acetaminophen (Tylenol) should NEVER be given to cats!

The final phase is Bereavement Care. Together, you and Dr. Freeman can discuss final arrangements such as cremation, or plan a funeral, the making of a memory album and locating a counselor or pet loss support group.

The goal of Pet Hospice is to provide comfort and dignity with a better quality of life during your pet's last days, while allowing you the opportunity to come to terms with the imminent loss of a beloved friend.

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Quality of Life Assessment

By Eric L. Nelson. MS, MA and Sharon Zito, DVM

Clearly distressed, tears in her eyes, Margaret said, "I still wonder if there was something else I could have done..."

Margaret's feelings and questions are typical for a grieving human who has just euthanized a companion animal. Questions torment, such as "Could a different treatment have been tried?" or "Would a different pain medication have given a few more days by providing greater comfort?" Such questions raise the possibility that the decision to euthanize was made too soon. For those who languish, this time would be less painful if there was a method to determine for certain when euthanasia should be administered.

There are many factors which contribute to such a decision. Some, such as chronic painful suffering, are clear indicators for an immediate euthanasia. Others, such as stiffness or incontinence are less clear. A system is needed which helps the human companion evaluate a pet’s totality of circumstance, and then yields a clear, unambiguous answer regarding euthanasia.

Methods

• Quality Of Life: looks at the overall experience of a pet's present existence.
• Pain Assessment: looks for signs of pain and suffering.
• Insight: looks into the companion animal's mind, in order to find out what they want us to do.

In this article we present three methods for making a euthanasia decision. All three should be used in order to fully evaluate the pet's circumstances. None of the methods are difficult to use.

Two of the methods (Quality Of Life and Pain Assessment) ask questions which correspond to numerical values. The numbers are added, and the Recommendation Table is consulted to determine if euthanasia is indicated. The third method, Insight, uses a thought experiment to look into the companion animal’s mind, in order to find out what she wants done.

The Quality Of Life Assessment is divided into seven categories of life experience such as walking and affection. As an animal ages, or as the course of a disease progresses, the quality of an animal's life experience will deteriorate. For example, a young cat can jump up onto a couch, whereas an older cat with arthritis will reach a point where he can no longer jump.

The Quality Of Life Assessment evaluates a companion animal's decreasing quality of life. Some characteristics are, by themselves, indicators for prompt euthanasia. For example, a pet who can no longer arise without assistance, or an animal that has lost bladder or bowel control, and who urinates or defecates on herself.

Quality Of Life Assessment
Walking
8 No longer can walk
8 Walks to eat, drink, or toilet only
1 Stiff, cannot run
Arising
8 Cannot get up without help
3 Arises slowly, is stiff
Eating & Drinking
8 Is not eating &/or drinking
5 Losing weight &/or dehydrated
Playfulness
3 Does not play anymore
1 Limited playfulness, reduced play interest
Toileting
8 Urinates or defecates on self
8 Painful urination or defecation on a chronic basis
3 Cannot hold urine or feces indoors / has accidents
Affection
5 Shows aggression when approached (fangs, growling)
3 No longer shows affection even when petted or rubbed
1 Only shows affection when laying down
Artificial Life Prolongation (ALP)
8 Is on 3+ ALP measures
5 Is on 2 ALP measures
3 Is on 1 ALP measure
   
  Total Points

Recommendation Table
Total Points Action
1-3 Re-assess every 90 days
4-7 Re-assess every 30 days
8+ Euthanasia recommended

Many characteristics are not, by themselves, an indication for euthanasia. For example, stiffness and reduced interest in play have small numerical values. Adding the smaller values together may generate a score which is high enough to indicate the time has come to euthanize, or the score may only indicate that the pet should be re-evaluated periodically.

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Pain Assessment

The Pain Assessment allows the human companion to estimate the amount of pain which a pet is experiencing. Unfortunately animals do not speak in human languages, so they cannot tell us in our language what amount of pain they
are experiencing. As a result, the human companion must look for behavioral signs which are then interpreted as indicators of pain.

Pain Assessment
8 Cries or moans when moving or re-positioning
4 Avoids all but necessary activity such as eating or toileting
2 Cannot climb stairs or inclines
1 Stiffness
  Total Points



Consider the example of a 14 year old German Shepherd, named Corrie. Her Quality of Life Assessment numbers were: Stiff (1), Arises slowly (3), Limited playfulness (1), for a score of 5. A score of five is not an indication for euthanasia; rather, it simply calls for re-evaluation every 30 days.

One day Corrie began to cry when she arose from lying down. This continued for two days, so this new behavior was not a transient symptom. Using the Pain Assessment method, Corrie's score was found to be an 8. Though her score on the Quality Of Life Assessment was still a 5, the Pain Assessment score indicated that Corrie had reached the stage where euthanasia was the humane action to take.

The third method is subjective and does not generate scores which can be checked on a recommendation table. Using the Insight method the human companion answers three questions in the way the pet would respond. Doing so illuminates the pet's wishes. When we put ourselves into our animal companion's mind, we may find that they want to be released, even though we - their human companions - are not ready to let go. The desires of the pet should be honored as a final act of love and respect for them.

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The Insight Method

   1. Do I want to be alive any longer?
   2. Do I still enjoy life?
   3. Am I ready to go?

When it is time for a beloved pet to be euthanized, typically it should be done within a day. If the animal is suffering, it should be done right away. If a veterinarian will make a house call, euthanizing your companion animal at home allows your pet to transition in a familiar environment. This reduces stress for you and your pet.

There will never be enough time to say goodbye to a faithful best friend; however, there are activities for saying goodbye that can be meaningful.

Saying Good-bye

• Gather humans and animals who love the pet, for a chance to say good-bye. The humans may want to light candles and put them in a sand tray while they share a few special words or memories. Soon, the room will be illuminated by many
glowing candles.

• Share a special time alone with the pet. Make a special meal, go to a favorite park, and spend time cuddling and petting. You might want to bring a camera for pictures.

There are many ways to memorialize a beloved pet, such as making a contribution to a local animal rescue organization, or building a web page with pictures of your pet.

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