It’s a scenario we all dread and a sobering reminder that our pet’s stay with us is never long enough: Fido suddenly becomes very ill, or quits eating, or is in pain with each step he takes, or begins coughing and vomiting blood. You quickly call your veterinarian and rush him in for diagnosis and treatment.
After a battery of tests and X-rays, the veterinarian either sends you home with a handful of medications until he/she receives the laboratory results the following day or refers you to a nearby emergency hospital in hopes of stabilizing the patient’s condition. And then the waiting begins. It seems like the longest 12 hours in your life until the phone rings the next day. Your optimism or glass-half-full outlook is suddenly crushed when the veterinarian says gently your dog is suffering from a terminal disease leaving it with only several weeks or possibly a few months to live.
Tears begin streaming down your face, and moments later your once-smooth psychological landscape is converted into a rocky mix of shock and pain.
It takes time – a few minutes, hours or even days, in some cases — to collect your thoughts, digest everything and then ask for your veterinarian’s suggestions on a course of action.
Quality of life is the No. 1 priority for this valued family member, but how to maintain that is equally important.
Pet hospice has become a valuable option – 40 years after the modern human hospice became an alternative for terminally-ill patients dying in hospital intensive-care facilities. The No. 1 caveat, however: Only a small percentage of veterinarians embrace the concept.
If the American Veterinary Medical Association national convention in Atlanta this summer is any indication, the door is slowly being nudged open. Several veterinarians, including Dr. Tina Ellenbogen, of Bothell, addressed large crowds there on cutting-edge hospice care and pain management and the need to incorporate these in their practices.
For two decades Ellenbogen has championed hospice care in her profession and practice, and she left Atlanta feeling good about its future. “Veterinary/animal hospice is here to stay. It’s a specialty on the rise, although it is not board-certified as yet. But with pain management becoming a specialty, hospice should follow,” she says.
“Conventional /traditional vets may not be embracing it yet, but they are seeing that clients know of it and want that option. Practitioners don’t have to incorporate it into their practice, but need to know those specialty practices and they can refer to those. They also need to recognize that they can incorporate the parts of hospice that interest them and refer the other parts.”
Ellenbogen, who operates a mobile practice, is often called upon to offer euthanasia services for beloved family pets in owners’ homes, but chiefly focuses on assessing the patient’s health status in the home with the family so that all parties can discuss end-of-life options and comfort care.
“Clients’ feelings vary widely,” she says. “The focus needs to be on orchestrating a peaceful, graceful goodbye without fear or regret. Some clients are well-prepared and some have a hard time letting go. This is no time for conflict or differences. I am in the home to provide comfort, relieve suffering and honor the pet.”
Dr. Carrie LaJeunesse, a Southworth (Kitsap County) veterinarian and president of the Washington State Veterinary Medical Association, says the organization “has always been progressive and open-minded. We recognize hospice as part and parcel of what veterinarians do. We obviously acknowledge that dying is a natural process and that we’re here to help the patients and their owners navigate that physically and emotionally.
“Because we are not trained to deal with psychological stress, we have our limits. Just like any other profession, some handle owner grief better than others. It’s incumbent on all of us to sit down with each grieving owner and ask what she or he needs beyond the medical care we offer. Then we must immediately find them the resources to deal with that.”
In Atlanta, Dr. Tami Shearer, of Dillsboro, N.C., led two sessions, “Quality of Life: Setting Up Hospice and Palliative Care Services in Small Animal Practice” and “Quality of Life: Hospice and Palliative Care Protocols,” emphasizing that as pets are recognized as family members, owners seek medical care that more closely matches that offered to humans.
Prompted by that demand, Shearer has developed a five-step protocol to guide veterinarians through a treatment mode:
(1) Evaluation of the owners’ needs beliefs and goals for the pet.
(2) Education about the disease process.
(3) Development of a personalized plan for the pet and owner.
(4) Application of hospice or palliative-care techniques.
(5) Emotional support during the care process and after the death of the pet.
After offering house-call services for years, Shearer founded the Pet Hospice and Education Center in Columbus, Ohio, in 2003. “My long-term vision was, and still is, that no one should have to euthanize their pet because they can’t afford palliative care,” she emphasizes.
One of the keys to the acceptance of pet-hospice in the mainstream veterinary community will be its emphasis in the curriculum of the nation’s 28 veterinary colleges. At this point only Colorado State University focuses on it to a limited degree.
Gail Bishop, co-founder and co-faculty advisor of the CSU program, explains, “Our curriculum does not include pet-hospice per se. We teach end-of-life issues and quality of life in many of our core classes, especially in the students’ junior and senior years. Those students who choose to volunteer with us receive pet-hospice education. But that is a small percentage.”
Those volunteers visit homes of terminally ill patients in nearby Fort Collins and Loveland, Colo., on a schedule dictated by the referring practitioner. During the visit they provide pain control and physical comfort in addition to assisting with prescribed hydration and nutrition therapies. Following each visit, the volunteer case manager updates the referring veterinarian of the patient’s physiological status.
Washington State University College of Veterinary Medicine offers “comfort end-of-life” advice in some of its classes, particularly those relating to oncology.
The International Association for Animal Hospice and Palliative Care (IAAHPC) is the nation’s premier umbrella organization promoting hospice/palliative care for animals as an alternative to premature euthanasia and to prolonged suffering. Its top priorities are to develop guidelines for animal-hospice care along with training courses and text books.
In 2001 and 2007, the American Veterinary Medical Association issued guidelines for veterinary hospice care, which were designed to be reviewed and updated regularly.
The challenge facing IAAHPC, as noted on its web site, “is that many animal owners/guardians/parents don’t know enough about animal hospice/palliative-care services to seek them; and that many veterinarians don’t know enough about the benefits hospice care can offer their patients and clients.”
While no statistics are maintained, Amir Shanan, a Chicago veterinarian and IAAHPC founder who has offered hospice services for 16 years, estimates only 5 percent of U.S. veterinarians recognize hospice philosophy as potentially beneficial to their patients and clients.
IAAHPC is an outgrowth of a need recognition born at a March 2008 international pet-hospice symposium at the University of California, Davis, College of Veterinary Medicine, designed to merge the medical aspects of end-of-life care with the psychological and spiritual perspectives. The event attracted 135 professionals from several allied fields; a follow-up meeting in 2009 drew about 100. A third symposium is planned for 2011.
The conferences were organized by Dr. Kathryn Marocchino, of Vallejo, Calif., founder of Nikki Hospice Foundation for Pets in 1998, the nation’s first nonprofit devoted to home care of terminally-ill companion animals.
Several steps in Marocchino’s multi-tiered definition of animal hospice pointed directly at practitioners read: “Animal hospice means seeing through the veil and viewing death not as an enemy to be feared but as a doorway to other states of being. Animal hospice means accepting that we have done our best with what we have been given during a specific moment in time but never feeling regret. Animal hospice means being willing to give death a chance without allowing fear, apprehension or our own discomfort to guide our decisions.
“Animal hospice means accepting death as a moment of grace and coming to realize that we are still learning, every step of the way. Animal hospice means allowing our animals to teach us what they know about death – far more than we can ever hope to know.”
Dr. Ella Bittel, a IAAHPC board member and holistic veterinarian from Los Alamos, Calif., says, “We all have become veterinarians because we love animals and want them to feel as well as possible throughout their lives. In that effort, in combination with not having received any education on what the best care could look like during the end of the animal’s life, we did not know any better than having euthanasia be the answer to about every end-of-life challenge.
“This led to us recommending euthanasia in close to 100 percent of the patients, with most owners complying, as they too believed there were no other options. There were, however, owners aware of the gap in care between what we give to our humans loved ones at the end of life and our animal family members.”
Bittel argues that with increasing public education of pet-hospice merits, clients will demand that option of the profession in the near future. Hospice, adds Bittel, is built on the concept that the natural dying process is not to be feared, or avoided and not to be postponed or hastened. It is a team-directed approach providing the highest level of comfort care on a physical, emotional and spiritual level to the patient and the family.
Shanan calls hospice a win-win for the pet, owner’s family, veterinary team and the veterinary practice. In addition to maximizing the animal’s quality and quantity of life, it provides the family empowerment, resulting in less stress, better decisions and some ease in coping with grief.
For the veterinary team, it offers the satisfaction of giving patients and owners a fulfilling end-of-life experience. And for the practice, it cements a stronger relationship with clients, who will likely return to the hospital with a future pet.
Dr. Alice Villalobos, a Woodland Hills, Calif., veterinary oncologist, noted speaker and writer, has long advocated the need for animal hospice in both emergency facilities and general practices.
“Offering Pawspice (pet hospice) would take the pressure off pet owners who cannot afford the large deposits of top-cabin treatment. With Pawspice as an option, a family can take its sick or injured pet home with pain medications and have the opportunity for an extended farewell until they make the final call for euthanasia.”
In a May 2009 Clinician’s Brief magazine story, Villalobos adds, “Veterinarians have a loyalty to their dying patients that creates an ethical dilemma. On one hand, veterinarians have taken an oath to prevent suffering and have been advised not discharge pets that cannot stand or function.
“On the other hand, when dealing with overtly terminal cases, veterinarians are asked to rethink the situation and provide hospice care. The attending doctor must be loyal to the patient’s physical needs during progression toward death, yet remain loyal to the client’s emotional needs and honor the human-animal bond.”
Web sites addressing pet death, dying, bereavement and animal hospice: International Association for Animal Hospice and Palliative Care, http://www.iaahpc.org ; The American Association of Human-Animal Bond Veterinarians, http://www.aah-abv.org/; Dr. Tina Ellenbogen, www.drtinavet.com; The Nikki Hospice Foundation for Pets, www.pethospice.org; Spirits in Transition, www.spiritsintransition.org; BrightHaven, www.brighthaven.org; Dr. Amir Shanan, www.compassionatevet.com; Partners to the Bridge, www.partnerstothebridge.org; Seattle Humane Society, www.seattlehumane.org; Washington State Veterinary Medical Association, http://www.wsvma.org/displaycommon.cfm?an=1&subarticlenbr=389.
set for Kirkland Sept. 19
The Animal Hospice End of Life Project will present “Intro to Animal Hospice and In-Home Care Giving” workshop at 1 p.m. Sunday, Sept. 19 at the Kirkland Women’s Club, 407 First St., Kirkland.
The event features several speakers and is open to the public. Families with geriatric or special-needs pets in need of increased levels of daily care giving are encouraged to attend as well as veterinarians and their support staff.
The speakers lineup and subjects: “Defining the Hospice Model,” Carol Soukup, RN, Partners to the Bridge; “Improving Quality in End-of-Life For You and Your Animal Friends,” Michelle Nichols, Partners to the Bridge; “Overcoming Obstacles to Compassionate Care,” Dr. Carl Bello, DVM; “Honoring the Bond: Experiences with Home Euthanasia and Natural Death,” Dr. Tina Ellenbogen, DVM; ”Honoring Their Memory: Remembrance and Memorializing,” Diane Dyer, celebrant.
Following these presentations, a pet owner’s panel will discuss personal experiences with animal hospice.
Partners to the Bridge is a local organization whose vision is for all animal lovers to appreciate the process of natural death with the availability of palliative care, enabling owners to choose the most dignified and peaceful ending for their pet’s life and avoiding euthanasia in crisis or under duress.
To register, contact Michelle Nichols, 425-223-5722 or www.PartnersToTheBridge.com.
Registration is $36.