Learn More About the Pet Hospice Program

Those veterinarians who would like to know more about the concept of hospice care for animals and exactly how it can be implemented in a veterinary clinic may wish to contact Dr. Eric Clough directly, at (603) 424-9922. Nonetheless, in order to provide some general guidelines which can be perused on this website, we have reproduced here the five-step plan developed by Dr. Clough in conjunction with his wife Jane. Hopefully, this will be of some use to those who wish to see how the program works.

Cures Sometimes

 

I. Hospice

• Definition. History in humans
• Translation to pet care: what we did in the past (evaluate and treat, decline to treat, or euthanize)
• The pet as a hospice patient
• The pet is terminally ill and has been given six months or less to live or, if unable to determine prognosis, we can say that the pet has a limited prognosis and a progressive disease with quality of life issues to consider

• The pet has evidence of clinical decline such as:

• Multiple visits to the veterinarian
• Multiple or extended hospitalizations
• Decline in functional status
• Functional status decline is evidenced in 3 out of 4 of the following ADIs (activities of daily living):
• Self-grooming
• Feeding
• Locating
• Ability to control urine or stool
• Righting
• Ability to ambulate
• The pet has impaired nutritional status
• Fluid retention or dehydration
• Weight loss
• Anemia
• The pet is symptomatic of pain or has dyspnea at rest
• The pet is unable to vocalize or vocalizes abnormally
• The pet has lost the ability to smile or greet its owner
• The caregiver has decided not to pursue curative treatment
• The owner, the pet's family, the veterinarian and the veterinary staff have been consulted and informed about the above
• Rationale
• Benefits to owners and their families
• Benefits to pets
• Benefits to veterinary workers

II. Appropriate Referrals

• Expected outcome
• Time frame (prognosis, anticipated disease progression)
• Palliative versus curative approach
• Symptomatic and terminal phase of chronic illness
• Caregiver profile: tasks of the caregiver

III. Components of Care

• Animal
• Pain and symptom control
• Wound care
• Incontinence and other aesthetics
• Behavioral presentation
• Owner
• Perception of pet comfort/discomfort (nurturance of child)
• Ability to alleviate discomfort
• Owner comfort/satisfaction
• Veterinary participation
• Knowledge and experience
• Open-mindedness
• Availability of doctor and staff
• Access to medications (we have it all available to us)
• Anticipation and presentation of symptoms
• Owner education
• Bereavement care

IV. Pain and Symptom Control (The AAHA recommends that veterinarians routinely consider administering analgesics to minimize pain in their patients)

• Pain and suffering: physical and psychic (pet and owner)
• Definition
• Assessment
• Owner interpretation
• Types of pain
• Opiate dependent
• Atypical
• bone
• nerve
• muscle
• Analgesic ladder
• Non-opiod
• Weak opiod
• Strong opiod
• Pain protocols
• KISS
• Avoid poly pharmacy
• Begin slowly and increase to avoid side effects
• Anticipate side effects
• Evaluate and educate (compounding pharmacies can supply or make almost anything)
• Dyspnea, coughing and sneezing
• Definition
• Assessment
• Owner interpretation
• Treatment
• Nausea and vomiting
• Causes
• >ICP, obstruction, fear, constipation, medication
• Treatment
• Seizures
• Causes
• >ICP, fever, metabolic source, hemorrhage
• Prevention
• Treatment
• Education
•  Agitation, restlessness, avoidance, vocalizing
• Causes
• pain, constipation, urinary retention, metabolic source, pre-terminal
• Prevention
• Treatment
• Stress to owner, especially with personality/behavioral changes
• Need to maintain successful "bedside" vigil
• Bleeding, wounds and incisions
• Hemorrhage control
• Cleansing, odor control
• Medication by primary caregiver (not for every owner, but will never happen without pro-active veterinarians and animal care professionals)
• Emergency Kits
• Dispense for anticipated and unanticipated events
• Injectables only which must be able to deliver medication in an efficacious manner under conditions of questionable absorption
• Use zip-lock bags with pre-loaded syringes of any or all of the above medications
• When to stop
• What to do when death occurs

 

V. Lessons From the Human Experience

• Provision of safe passage at home
• Growth at the end of life
• Fear of death and dying
• About our pets
• About ourselves
• By our clients
• By our clients for their pets
• Opportunities presented
• Client and family
• Coming together, cooperation, reconciliation, lessons learned
• Veterinary staff
• Continuum of care, completing a cycle, bonding
• Beginning again!