Palliative Care for Pets
Article submitted by Dr. Jessica Pierce - Bioethicist and Writer. Her most recent book, “The Last Walk: Reflections on Pets at the End of Their Lives” is about the challenges we face as our companion animals grow old. Learn more at her website - www.jessicapierce.net
Palliative care refers to the effective management of pain and the provision of comfort care, most often to ill or dying patients. Most of us are familiar with the concept of palliative care for humans, but palliative care is increasingly available for our companion animals, too. Palliative care is often coupled with hospice care, which allows a pet owner to provide comfort care for a dying animal, usually in the home and with the assistance of a veterinarian or veterinary nurse. Hospice and palliative care focus not on keeping an animal alive, but on maximizing the quality of her final days—making sure that she is comfortable and experiences more pleasure than pain.
What does palliative care involve?
Veterinary medicine has excellent tools for managing pain in animals. The central element of palliative care is, of course, the management of pain through the combined use of various drug and nondrug therapies. The list of possible pharmaceutical treatments looks quite similar to what we use in humans: local anesthetics (e.g. lidocane), steroids (e.g., prednisone), opioids (e.g., morphine, tramadol), and nonsteriodal anti-inflammatory drugs (e.g., carprofen, meloxicam). Nondrug therapies such as massage and acupuncture can also be very effective.
Depending on the condition of the animal, palliative care might involve infection control, nutritional support, non-curative surgical procedures, canine rehabilitation (like physical therapy for humans), hydrotherapy, or laser therapy. As with human pain treatment, a “multimodal” approach to pain works best. Using several different therapies—for example, combinations of different drugs or drugs combined acupuncture—creates a synergistic response and can be far more effective than a single therapy. Also, a “preemptive” approach to pain is most effective: the use of analgesics prior to the onset of pain will dampen the pain response. Once pain has fully kicked in it is more difficult to control.
How do you know if an animal is in pain?
A basic rule of thumb is: if you think your animal might be in pain—if the question even enters your mind—he or she probably is and you should seek help from a veterinarian. Research shows that nonhuman animals experience pain in much the same way as the human animal. Which leads to a second rule of thumb: If you think something would hurt, it will probably hurt your animal, too.
Like humans, animals can suffer both from acute pain and chronic pain. Acute pain is much easier to recognize—your animal will likely show obvious signs of discomfort like vocalizing, licking, refusing to move a certain part of the body, or pulling away from your touch.
Chronic pain can be a little harder to observe. Sometimes we assume that our dog or cat is just “getting old” and that being stiff and slow are signs of old age. But stiffness and loss of mobility can also be caused by painful medical conditions such as osteoarthritis. Changes in an animal’s behavior, such as incontinence or increased anxiety, can also signal that she is in pain. Although we can’t always cure what ails our dog or cat, we can and should treat our animal to control symptoms and pain.
A very common approach to our animal’s health is what I call “if it ain’t broke, don’t fix it.” People don’t take their animal to the vet unless and until it is quite obvious that the animal is in profound distress. There are several problems with this approach. Most importantly, we sometimes don’t know that things are awry just by looking at the outside. For example, my little pointer Maya seemed fine, but I had the vet do a blood panel when Maya turned seven (this is the age at which a dog is considered elderly, and bi-yearly blood panels are recommended). It turned out that she had something going on with her liver, and putting her on medication right away has kept things under control. Often if we wait until the signs of illness are obvious, it is much more difficult to treat—and sometimes it can simply be too late.
Is palliative care expensive?
Many people worry that continued care for an ill or disabled or elderly animal will be costly. Deciding to provide palliative care for an animal is more expensive that basic well-animal care. At the same time, palliative care is generally far less expensive than aggressive curative treatments. As with human medicine, there are different tiers of care. The more money and time you have, the more you can do for your animal. The “bronze plan” might involve basic pain medications, and will be fairly affordable. The “silver plan” might include injections for managing symptoms or more expensive classes of drugs or specially formulated diets. The “gold plan” might include massage, acupuncture, laser therapy, rehabilitation, and other therapeutic modalities.
People on a very limited budget will likely have to make some hard choices. If a pet owner simply does not have the resources to manage the pet’s pain, and if the pain is severe, it is worth considering euthanasia. (Some areas have nonprofits set up to help seniors on a tight budget take care of their pets.)
If you can afford it, a mobile vet who will come treat your animal in the home is worth the extra cost (in my experience, the cost is generally only $15-20 more per visit, though this could vary). It is more comfortable for an animal—especially a sick one—to be at home and also more comfortable for people who face their own health challenges and for whom a trip to the vet is exhausting or painful (or who simply don’t like sitting and waiting for long periods in a veterinary office). If and when you decide it is time to euthanize your pet, a vet can do this in your home and can make the procedure very peaceful for the animal and his or her human family.
Who provides palliative care for pets?
Effective palliative care requires the expertise of a veterinarian, preferably one with special training and interest in hospice and palliative care. You can search online to see whether there is a specialist in your area (google “veterinary pain specialist” or “animal hospice” or check the International Veterinary Academy Pain Management’s website, which lists certified veterinary pain specialists ivapm.org. There are also specialists in canine rehabilitation, massage, acupuncture and other complementary therapies, and these practitioners can help manage animal pain effectively. Veterinarian nurses and veterinary technicians are sometimes specially trained in hospice, and can be a valuable part of your pet’s care team.
What if you can’t find a specialist? Don’t worry. All vets are trained to treat pain and can help you come up with a careful plan.
Although your vet will help you figure out a plan of care, the most important part of your animal’s care team is you. Good pain management requires cooperation and careful coordination between pet owner and veterinarian. You must be an advocate for your animal, making sure that your animal’s pain is under control and that your animal still experiences a good quality of life. It is up to you to observe and report physical and behavioral changes in your animal, to judge whether your animal is happy and comfortable, and to stick by your animal as loyally as they have stuck by you.
More about Jessica Pierce
Dr. Jessica Pierce is a bioethicist and writer. She is the author of six books and numerous popular and scholarly essays on bioethics and animals. She lives in Colorado with her husband, daughter, dog, and cat.
Read an excerpt from Jessica’s book “The Last Walk: Reflections on our Pets at the End of Their Lives.”
© 2012, All Rights Reserved by Dr. Jessica Pierce.
Posted November 2012 on www.SeniorsResourceGuide.com