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One weekend, Nancy Hurley found herself staring at X-rays at an emergency clinic, where she'd taken her elderly Sheltie after the dog fell. Like many pet lovers before her, Hurley heard the advice that no one wants to hear.
“The veterinarian told me that it was time for euthanasia,” says Hurley, who lives in Charleston, W.V. “I thank God I didn’t do that. I dropped the X-rays at my own vet’s the next day, and we started talking options.”
The option she chose was hospice, an approach to end-of-life care in which a terminally ill pet lives at home and receives care from what can be a range of experts, such as traditional and alternative-care veterinarians, physical therapists and mental-health professionals.
That was last January, and Hurley’s 14-year-old Sheltie, Savannah, is still with her. She still mugs for pictures, begs for biscuits and barks happily while her owner sings “Savannah Banana” to her. There have been good days and bad days, but Hurley and her dog have enjoyed something relatively rare in veterinary medicine: time together after a diagnosis of an advanced terminal illness, cancer in Savannah's case.
“The path to death was detoured a bit,” says Dr. Robin Downing of the Windsor Veterinary Clinic and The Downing Center for Animal Pain Management. An internationally known expert in pain management, Downing has assisted Hurley’s veterinarian in Savannah’s case, after the dog’s owner clicked into an online seminar on pain management the veterinarian gave. Hurley contacted the Windsor, Colo.-based veterinarian, and Downing has been on Savannah's hospice team ever since.
“Dr. Robin is an angel,” Hurley says.
Though many of Downing's clients share the belief that Downing is heaven-sent, her veterinary colleagues know Downing more as one of a handful of strong advocates for palliative care, the practice of keeping animals pain free and comfortable in their final days, weeks and months. “We needed to find a way to help these animals live until they died," Downing says. "That’s what hospice is about: living fully."
Since the 1990s, the introduction of a series of effective nonsteroidal inflamatory drugs (NSAIDs such as Rimadyl, Metacam and Deramaxx), along with the increased acceptance and use of complementary pain medications, changed veterinary practice. Previously, many veterinarians had avoided pain control for animals after surgery: The consensus view was that if moving hurt, a pet would be more likely to be still while healing. That thinking was changed by research showing that animals heal more quickly when pain is controlled. For veterinarians such as Downing, these improvements in pain management made it clear that in some cases, they could also ease the suffering for animals for whom they could do little else.
Veterinary oncologist and hospice advocate Dr. Alice Villalobos of the Animal Oncology Consultation Service in Woodland Hills, Calif., notes that this idea was counter to what veterinarians had been taught for decades.
“We were taught to offer euthanasia when a pet started faltering," she says, "and we have all been educated to focus on care for the pet’s life stages. But end-of-life care was not included, and it is a life stage.”
Villalobos tells Vetstreet that only a small percent of the nation’s veterinarians offer end-of-life care, but there are signs that this is beginning to change. Indications of the increased interest include the first-ever pet hospice symposium at the University of California, Davis School of Veterinary Medicine in 2008, followed by the founding of the International Association for Animal Hospice and Palliative Care the following year. The AVMA recently revised guidelines to emphasize that “veterinarians who do not offer hospice services should be prepared to refer clients to a veterinarian who does.”
Though advances in veterinary pain management have helped propel the idea of hospice, that’s not all there is to palliative care. Other means of easing an animal’s suffering may include regular subcutaneous fluids to improve hydration, oxygen therapy and assistance devices such as slings to support weakened hind ends. Hospice help may also include physical and massage therapy as well as such things as covering slippery floors with rugs for better traction or helping find or develop diets that support a patient who may not want to eat.
Complementary veterinary medicine, such as acupuncture, can be part of the package as well.
As with human hospice, the work also involves helping the family cope. In this regard, the Argus Institute at Colorado State University’s Veterinary Teaching Hospital is the model to build on. Founded in 2002, the program offers a free service to the community, working through area veterinarians and staffed by volunteer veterinary students as well as mental-health professionals to assist pet owners in dealing with their pending losses and in working with their own veterinarians to provide home hospice for their animals. Some of what they provide is educational resources and information, but hands-on work includes having volunteers teach families medical home care skills so they can better take care of the needs of their pets.
"Because of my human hospice experience, I know that families aren’t ready to say goodbye,” Argus Institute co-founder Gail Bishop says. “This lets us give them the resources while providing a great opportunity for our students.”
The veterinary team’s assistance in helping pet owners recognize diminished quality of life and time euthanasia is also part of the hospice experience. Villalobos has developed guidelines that many veterinarians and pet lovers use to help identify the signs of suffering, so that pet owners and veterinary care teams have an objective guide to refer to in making tough decisions.
Hurley knows her Savannah is near the end of the journey. Last week, she sent an email to her friends saying as much, as well as to Downing. She has discussed with her veterinarian her decisions for saying goodbye to her beloved pet. She already knows where the ashes will be scattered, even as she hopes her dog will rally just one more time.
But it wasn’t Savannah on her mind when asked for her final thoughts on the pet hospice movement.
“When I took Savannah out of the emergency clinic that day, I sat sobbing with her in the car while my husband went to pay the bill,” she says. “And while I waited, I saw a man carry in an elderly Cocker.”
Her husband came out and told her that the man had brought the dog in because of trouble walking and pain. Hurley wonders if that man was told there was no choice but to say goodbye.
“I sometimes wish I could go back and go in after him and catch him," she says. “There is another way, and I wish more people knew it.”
Editor's note: Savannah lost her battle with cancer not long after this article was written. Our condolences go out to her family, and our thanks to them for sharing with our community at such a sad time in their lives.
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