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Hospice and End of Life Care

Hospice and End of Life Care

One of the hardest decisions you will likely have to make is deciding when it is time to let your beloved pet go. Sometimes the choice is an easy one; your pet’s disease has progressed and they are obviously distressed. Other times it can be difficult because your pet’s symptoms wax and wane or because in some areas they are worse but others the same or even better.

Our biggest concern here at the Cancer Center is quality of life (QOL) and maintaining it as long as possible. While there are some minimums to QOL, exactly where the line is drawn is a deeply personal choice. You, as the caregiver for your pet, are the best person to evaluate how they are doing in their daily life. Keeping a record of how your pet is doing daily, will help you evaluate how they are doing in the long run. We can give recommendations based on what we see in the clinic, but ultimately it is a decision that you and your family must make. Remember, too, that your pet has been diagnosed with a terminal disease, and there is no wrong decision to make in regards to your pet so long as they are happy and comfortable.

As difficult as the thought of euthanasia and end of life care is, it is important to talk with the members of the immediate family ahead of time. Knowing what actions will be taken, when they will be taken, and who is ‘in charge’ of making those decisions, will help make that time, when it comes, go much more smoothly. Consideration should also be given to aftercare and what ways, if any, you’d like to memorialize your pet.

This section contains some information about assessing quality of life, euthanasia (what it is and options for it), and options for aftercare of your pet. Also included are some pet grief and counseling resources for those who are interested or in need of them.

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Quality of Life

Quality of Life

Quality of Life (QOL) is how happy and ‘good’ your pet is doing on a day-to-day basis. For us at the Cancer Center, QOL is the main driving force behind what we do. From the first time we see your pet to the last, QOL is our top priority. QOL, though, is more than just the clinical side of how your pet is doing. There are several different factors that play into QOL and most of them involve how your pet is at home. The importance of each area and how it affects QOL is different for each family, and can even differ from one pet to another.

QOL should be assessed often after your pet is diagnosed with any disease. The exact frequency will vary based on your pet’s specific disease and how affected they are by it. At a minimum, QOL assessments should be made monthly or after any significant change in the status of your pet’s health. Weekly, or even daily, assessments may even be appropriate to best monitor your pet. You should do what feels most comfortable for you. If daily assessments help you feel in control of your pet’s QOL, then by all means do them, even when they are doing great. It is also important to review your pet’s previous assessments from time to time. This helps you see both their response and their progression. Some changes take time to notice and ‘normal’ for your pet can change without you realizing it.

The following is a list of questions you can ask yourself about your pet to help determine what QOL means for the both of you, what you are willing and/or able to do, what is acceptable for your pet to experience, and what is not. There will also be a list of explanations of some of the more common areas that help determine QOL. It is also important to discuss your goals and limitations with your doctor, as well as bring up any questions or concerns that you have with them. They can help guide you down this often difficult path and aid you in making educated decisions about, and for, your pet. We have created a QOL assessment table that you can use to monitor your pet. You can also take the information you get from the following pages and create your own that is tailored specifically to your pet and family.

Questions to consider

  • Is my pet experiencing pain? If so, how severe is it?
  • Can they eat, drink, urinate, and defecate normally/on their own? Am I willing or able to help them if they can’t?
  • Is my pet nauseous, vomiting, or having diarrhea/soft stools? If so, how often and how severely does it affect them?
  • Are they able to keep themselves clean and sanitary? Am I willing or able to do this for them if they can’t?
  • How is my pet doing mentally? Are they bright and alert? Are they mentally aware of their surroundings? Do they seem quieter than normal, or mentally altered? Are there any new behaviors that are concerning or hazardous to my pet or others in the household?
  • How much time can I realistically set aside to provide more intensive medical care for my pet? What am I able to provide financially for the care of my pet?
  • Do the good days outweigh the bad days? Are there more good days than bad days?
  • Is my pet able to experience or do the things they enjoy most?
  • Are there any side effects, symptoms, or medical conditions that I will not tolerate my pet experiencing?
  • Is euthanasia something I will consider for my pet? How much value is placed on the opinion of the veterinary team when it comes to recommendations about treatment versus euthanasia?

Areas to consider

  • Mobility is how well your pet can get around and how they feel when they get around.
    • Good: gets around without assistance; enjoys walks/playing; doesn’t hesitate to move around or jump up/down
    • Limited/poor: needs some help getting up, down, and/or around; can only walk or play for short periods of time; hesitates or isn’t able to jump or walk up/down stairs; has difficulties posturing to eliminate; pain can be controlled all or mostly with medications
    • None/minimum: requires assistance to get around or isn’t able to move at all; pain cannot be adequately controlled with medications
  • Nutrition includes what your pet is eating, how well they are eating, and how much of the nutrients your pet is absorbing.
    • Good: will readily eat their regular diet and eat an appropriate amount of food for their size; maintains their weight and appropriate muscle condition; missed meals, vomiting, and diarrhea are a rare occurrence (not more than a couple times a month or for more than a day or two in duration).
    • Limited/poor: will eat only some of their meal and/or needs some encouragement (verbal coaxing, hand feeding, etc.)  to eat; body and muscle condition decreases but is still acceptable; will only eat ‘special’ foods and treats; appetite waxes and wanes; missed meals, vomiting, and diarrhea occur often (only a couple times a month and lasts for only a few days at a time or sporadically for only a day or two but for at least 3 weeks out of a month).
    • None/minimum: will not eat at all; will not eat regular food but can be encouraged or coaxed to treats and ‘special’ food; body and muscle condition has decreased dramatically; missed meals, vomiting, and diarrhea occur several times a week to daily.
  • Hydration is how well your pet is able to maintain appropriate fluid levels in the body. This includes both increases and decreased in fluid intake. It is important to distinguish changes in hydration that are causes by the disease from those caused by medications.
    • Good/normal: stays adequately hydrated on their own without assistance or coaxing; urinates normally and of an appropriate volume
    • Poor/inappropriate: drinks more or less than normal; may need SQ fluids to maintain hydration or medications to remove excess fluid from the body; urination is altered based on the fluid intake
    • None/extreme: is not drinking at all or cannot stop drinking; need IV fluids or water rationing; urination is absent or very frequent
  • Attitude/Mentation is how your pet is acting and interacting with you and other members of the family. This can also include how many normal activities your pet voluntarily does.
    • Good/normal: is interactive, bright, and responsive to you and other members of the family; readily participates or wants to participate in normal family activities; seems happy and appears to be enjoying life.
    • Limited/poor: will interact some with family; might not interact as often or be as enthusiastic; may seem to ‘dragging’ or quieter than normal; will do some normal activities but not others; is responsive but might take more effort to get a reaction
    • None/minimum: will not interact at all or very little, even after a lot of effort; hides or runs away from interactions; will not participate or must be forced to do normal activities; is very quiet, minimally responsive, or not conscious at all.
  • Unique traits and favorite things can help you to monitor just how ‘happy’ your pet is. What falls into this category is different for each pet but include any activity, habit, or hobbies that your pet does.
    • Good/normal: participates in activities and acts normally
    • Limited/poor: desire to participate can vary or be limited; traits or habits may be decreased; may want to do it but can’t or won’t actually participate.
    • None/minimum: will not participate in most or any activities/hobbies; show no interest in activities/hobbies; traits are decreased or absent

Quality of Life Assessment Tool

This table can be used to track your pet’s quality of life.

Answer the questions as best you can by choosing the answer that fits best since the last assessment was taken. If this is the first assessment or an assessment after a significant change in health, choose the answers that best fit the symptoms your pet is currently having. 

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Euthanasia and Aftercare

Euthanasia and Aftercare

Euthanasia is the intentional ending of a life to stop overwhelming pain and suffering. Understandably, the decision on whether or not to euthanize is a deeply personal one. While we would all hope that our pets would pass quickly and quietly in their sleep, sometimes steps must be taken to end it sooner in order to spare them unnecessary pain and suffering.

In veterinary medicine, euthanasia is accomplished by the administration of an anesthetic overdose. By using anesthetics, we can ensure that your pet passes with a minimal amount of distress. The nature of anesthetics means that long before the body systems stop functioning, your pet has reached a state of unconsciousness. While the body may still react to outside stimulus or perform involuntary actions, your pet will not be mentally aware, in pain, or distressed by these actions.

Once the decision to euthanize has been made, the next decision is whether you would like to be present with your pet for the procedure or not. There is no wrong choice when it comes to this since it a very personal decision. You may also need to decide if there are other people or pets that you would like present for the procedure. Most veterinary clinics are able to perform euthanasias. If you would like your regular vet to perform this service for you and family, please contact them with any questions you have about how they perform the procedure and to get you scheduled. You may also want to have this done at either your own home or at our office. On the next page, you will find a list of a few mobile veterinarians. Below is some general information about euthanasia at the Cancer Center.

Here at the Cancer Center, if you decide to be present, an IV catheter will be placed to help ensure that procedure happens quickly and smoothly. The doctor will go over the procedure prior to beginning and will wait until you are ready before proceeding. Once the procedure is complete, the doctor will verify that your pet’s heart has stopped beating. You can spend as much time as you need with your pet, both before and after. There is no rush.

If you decide not to be present, your pet will still be surrounded by love. An IV catheter will be placed and one or more staff members will sit with your pet as the doctor performs the procedure. Your pet will be offered words of love and signs of affection, as if they were our own, to ensure that their last moments are as happy as we can make them.

Aftercare is what is done with your pet’s body after death or euthanasia. The options are the same as they are for people: cremation or burial. With cremation, you have the option of an individual cremation in which your pet’s ashes are returned to you, or a communal cremation in which your pet’s ashes are not returned to you but instead scattered after cremation. Burial can either be accomplished at home (depending on the laws where you live) or at a pet cemetery. Depending on your wishes, we are more than willing to help facilitate the aftercare that you would like for your pet.

In-home Hospice Care and Euthanasia

The following is a list of veterinarians that perform house calls. In the event that your regular vet is unable to make house calls, the following providers can perform a variety of services, from general wellness care to hospice and euthanasia. Each provider is different in what they offer and the area that they are able to cover. Please contact them or refer to their websites for the specifics of what they are able to provide to you and your pet.

Olympia and South Puget Sound Area

Peaceful Transitions Veterinary Services, Dr Blair Burggren

(360) 791-5500

http://www.peacefultransitionservices.com