Orally disintegrating tablets can be a game-changer in administering medication in some pets

Several weeks ago, I highlighted the topic of vestibular disease in dogs after a diagnosis with one of my charges. And while it’s not a life-limiting diagnosis, the accompanying symptoms can most definitely diminish a pet’s overall well-being and ability to cope until it resolves. That takes a goodly amount of patience, environmental management and supportive care to get there. The supportive care part is par for the course with most diagnoses, and how that’s carried out can take a bit of creativity. 

The source of the vestibular issues with the pet referenced previously took a little time to sort out, which isn’t unusual with some diagnoses. And so, symptoms that initially got better for them but then intensified by week’s end found the family back at their primary vet clinic to get things under control. 

After the vet’s assessment of a middle ear infection, they discussed what would be indicated to provide that supportive care that was critical for the pet’s comfort. And as the vet team was getting things in order, the family texted me to help generate any questions they should have for the vet team as a final plan was put together. 

One of the biggest concerns that I had was that the family might not be as prepared as they needed to be going home given that this was all unfolding on a Friday afternoon. And, going headlong into a weekend with a dog who was already assessed to be mildly dehydrated due reduced water intake because of the inability to keep their head up long enough to drink, let alone the nausea they were experiencing, I could easily envision a very complicated situation needlessly unfold. I made some suggestions for the family to run past the vet if they’d not put them in the treatment plan in an effort to avoid any hurdles over the weekend. One concern was top of mind. This dog had been nauseous all week due to the vestibular problems. And while anti-nausea (anti-emetic) medication was sent home earlier in the week in tablet form, I knew that actually administering a capsule or pill correctly, even a tiny one, would be a real challenge for a dizzy, nauseous, dehydrated dog with a decreased appetite and a worried guardian. And so I urged the family to ask about an option that could be used to be equally effective but easier to administer.

Gratefully, the vet consented to the client’s request—anti-nausea medication prescribed as orally disintegrating tablets—to be used as a backup plan should they be needed. 

Though orally disintegrating tablets, or OTDs, aren’t available as an option for every medication, they are for some very critical ones in human medicine and veterinary medicine. And as the name suggests, they are designed to dissolve in the mouth and do not need to be swallowed. That’s a boon for hard to medicate pets—including cats—and as a Certified Animal Hospice Practitioner and Certified Fear Free Professional, I love the option for pets who are receiving chemotherapy or are on hospice. Expect to have medications that have been prescribed as an ODT to be more costly and filled either through a regular pharmacy and some veterinary compounding pharmacies. 

I’m happy to report that the doggo in question made it through that weekend with little issue and has had a smooth recovery, which is the goal. And I enthusiastically encourage each of my families to advocate for themselves and their pets (and I happy do that for them as well) if they’re not feeling confident about being able to be concordant with a treatment or comfort care plan that their vet has put together and tell them that. Most often, vets are happy to figure out a plan b or in this case, make a minor adjustment that made all the difference. The biggest hurdle for families often is actually administering medication, but these days, there are more options than ever to make those interactions easier, safer and as importantly, they preserve the human-animal bond in the process. 

With over 20 years of experience in pet care and the past 10 of those focused on animal hospice, Lorrie Shaw is a Certified Animal Hospice Practitioner and Certified Fear Free Professional. She is CXO of Telos Companion Animal Services, LLC and can be found at lorrieshaw.com.

Unsteady as she goes: canine idiopathic vestibular disease

It’s not unusual for me to get a text or phone call any hour of the day from families-of-record if their pet is presenting with symptoms that are concerning, or behavior is at all unlike them. (Because we know that a change in behavior is in itself a symptom, right? Of course!) My families know they can get in touch anytime in these situations, and though I can’t diagnose their pet, I can definitely assess the situation and give good guidance on next steps and what to expect if and when their primary vet or an emergency vet needs to be involved. And if I’m able, I’m happy to come by to assess what’s happening and offer support. 

And this weekend, one of those calls came in. 

A very unnerved guardian detailed what they’d just witnessed in their very active and happy senior dog with a sound medical history: sudden onset of stumbling about/staggering/lack of coordination (ataxia), vomiting once, and a little confused. Definitely alarming, was my initial thought, though with my professional training to assess, experience and employing the principle of Occam’s Razor—the simplest explanation is usually the best one—I had a solid basis to work from. Also, I don’t panic. That’s unhelpful. 

The possibility of a stroke crossed my mind, or them having come into contact with a toxin. Other things too, but all of that was far less likely than what I felt was probably going on. 

Upon arriving just a few minutes later to assess things, I could see what the guardian was talking about. Though improved, and possessing otherwise normal vital signs, the pooch was still mildly unable to reliably coordinate their movements, and a little drooly (indicating nausea). They also had a telltale symptom that rounded out what I was expecting to see: though their pupils were equal in size, their eyeballs were moving back and forth like ping pong balls, a symptom called nystagmus. 

“I feel pretty confident based on what you’ve told me about what the past few days have looked like—rather ordinary— and what I see, is that they are experiencing an issue with their vestibular system,” I explained. 

“I’ve seen this before in senior dogs. Though it’s typically idiopathic, not life-threatening and resolves in a short time, I can’t say for sure that’s the case. A vet would need to do a proper assessment, diagnostics and history to rule out other possibilities.” 

The guardian agreed with my advisement to have them assessed immediately as a precaution, and so off to a local emergency veterinary hospital we went. (And of course, said pooch was 90% improved, by this point!) With otherwise normal vital signs assessed, the verdict from the veterinary team a short time later was what I’d expected: canine idiopathic vestibular disease.

Sometimes referred to as Old Dog Vestibular Disease (wince with me here) since it’s more common in senior and geriatric dogs, canine idiopathic vestibular disease is a diagnosis that can feel understandably scary upon its swift onset and presentation. No one likes seeing their pet wobbly, vomiting, sometimes struggling to stand. Stemming from an issue in the middle ear rather than the brain, it’s not known why it happens. 

The good news is that it tends to resolve quickly without intervention aside from any necessary supportive care, usually within weeks with no lingering problems. Below are things that are very helpful in managing the symptoms:

• Maintaining a safe environment indoors, especially blocking off access to stairs, is essential of course, as is close supervision outdoors. Consider nightlights for the overnight hours to help the pet navigate with more ease.

• Providing easy access to resources of food, water and places to rest/sleep. 

• For pets that are having difficulty in relieving themselves due to the wobbliness, I find that having them wear a harness is super-helpful. That way, you can help stabilize them as they are trying to urinate or defecate.

• If a pet is finding it too difficult to hold a position long enough to urinate or defecate even with assistance, they may develop issues with keeping themselves clean. It’s sensible to tend to their hygiene needs regularly and be watchful for urine scalding, matting and soiling. All of these impact the integrity of their skin and their overall well-being. 

• Supportive care, like medication to assuage nausea can be helpful for those pets that need it. Your veterinarian will likely send this home with you as a precaution. If your pet is having a hard time being upright long enough to drink water, consult your veterinarian straightaway so that they can decide on a plan to assist with hydration. 

At last check in this afternoon, I’m happy to report that said pooch is in fine form, and their guardian, relieved. 

For more on canine idiopathic vestibular disease and other vestibular disorders, click here. 

With over 20 years of experience in pet care and the past 9 of those focused on animal hospice, Lorrie Shaw is a Certified Animal Hospice Practitioner and Certified Fear Free Professional. She is CXO of Telos Companion Animal Services, LLC and can be found at lorrieshaw.com.

Dog booties are helpful for senior and geriatric dogs in every season, but which ones are best?

Dog booties are used to protect a pet’s paws from the elements, mostly in winter. The products used to melt ice can wreak havoc on the pads, as well as the skin between, and for some dogs, the cold is just too much. Booties are ubiquitous in my day-to-day as a professional specializing in caring for senior and geriatric pets and those who are receiving animal hospice and palliative care. Aside from the reasons above, they’re used to protect the top and bottom of an an aging dog’s paws when degenerative myleopathy is present, or when they need more grip on bare surfaces, like when mobility is becoming less stable. 

There are lots of brands and styles, but few really measure up to the outstanding protection, affordability and usefulness that the Pawz brand does. My lending library gets lots of donations from families-of-record that I’ve worked with as a Certified Animal Hospice Practitioner, and there’s an abundance of various other brands in it for good reason: they just don’t work as well as they need to. They won’t stay on, they’re too clunky and pose a risk of tripping, or they’re just hard to use. 

Pawz, on the other hand, they stay put. Their simplistic design is why they work—they look exactly like a balloon—but it’s also a double-edged sword: they’re notoriously hard to get on. The small opening lends a snug, secure fit, but trying to open one up whilst fitting a dog’s paw inside is like wresting a boa constrictor. 

The tutorial below details how even those caregiver guardians who need to hurdle that obstable, can, with an unexpected tool. 

With over 20 years of experience in pet care and the past 9 of those focused on animal hospice, Lorrie Shaw is a Certified Animal Hospice Practitioner and Certified Fear Free Professional. She is CXO of Telos Companion Animal Services, LLC and can be found at lorrieshaw.com.

Observing sedation as a side effect of a pet’s pain medication—or is it something else?

There are a few things that pet guardians rate as important when addressing the needs of their aging or terminally ill pet: they don’t want them to suffer, they want them to eat and they don’t want to see them zorked out and sedated on pain medication. And as a Certified Animal Hospice Practitioner, when I’m supporting families as we are discussing pain management with their pet’s veterinarian, the side effects are top of mind for them. (Some medications are sedating, at least temporarily though in many cases the sedation can be a big help, but I digress.)

Those concerns about sleepiness are valid. And when a family gets on board with adequate pain management, I can tell you it’s not a moment too soon. 

The pet does in fact typically sleep more, but it’s easy to focus so much on how drowsy a pet seems as a side effect of meds and not take into account that maybe, for the first time in a long time, the pet has attained a level of comfort because of the medications doing their intended job and assuaging the chronic pain that’s plagued them. The intended effects of those meds that allow them to sleep so long and deep and well because they’re finally comfortable, when that comfort has been fleeting for far too long. Fleeting, because of chronic pain that is very much a diagnosis all on its own that’s been discounted, and has impeded good sleep. 

Pets in later stages of life require lots of sleep and rest. It’s crucial to their well-being. 

Pain medications that a vet wants to prescribe are not an enemy. They are a blessing and prescribed appropriate to a pet’s changing needs, are an essential consideration of a palliative care plan—an ally.

With over 20 years of experience in pet care and the past 9 of those focused on animal hospice, Lorrie Shaw is a Certified Animal Hospice Practitioner and Certified Fear Free Professional. She is CXO of Telos Companion Animal Services, LLC and can be found at lorrieshaw.com.

Want advice on feeding your infirm pet? Skip the armchair experts, go to the professionals

Food is one of those most important topics that is discussed in the focus of my work, and it’s not surprising. 

I use it as a positive reinforcement tool when I’m performing care duties for a pet, and I teach families how they can, too. It’s used as part of enrichment strategies that are appropriate to a pet’s telos, physical ability and emotional needs. 

Food is sustenance. 

It brings joy to families when they’re feeding their pet and it’s well-received, since it signals that the pet is feeling good about things and that they are doing at least reasonably well. 

Pets need food to survive, at least until they are approaching the stage of animal hospice-supported natural death, where food becomes more of a burden than a support, but that is a topic best reserved for a post all on its own.

I’m often asked about what I think in terms of what food or foods are best for a pet. As a seasoned Certified Animal Hospice Practitioner (CAHP), I am qualified to speak to whether it not specific foods are safe for a pet (think foods and ingredients that are inherently toxic, or those that can trigger GI symptoms, like those that are high in fat). It’s also totally fine that I make safe suggestions on strategies that can help a pet be more willing to eat or hurdle an off day when an appetite is flagging to see if that’s helpful, before having to have the vet weigh in. This is actually good to do, since if it doesn’t help, the vet can use that data to decide what next steps should be. 

The truth is, beyond that, I’m not the person to ask about what food or foods or are best for a pet. That’s not my lane. My professional training isn’t in veterinary nutrition, animal nutrition, or Traditional Veterinary Chinese Medicine (TVCM), where food is a focus of adequately supporting the patient. And those are the professionals whose lane that is. Yes, I get it: it’s not a popular point of view, and in fact my position is in conflict with many people who tout themselves as experts. 

When a family expresses a hearty interest in supporting their pet’s well-being with food, I’m fully on board with that. Food is one of the cornerstones of supporting health. And when a pet is experiencing a health challenge, or age-related decline and even the journey through hospice, food can be a tool in the box to help them feel and do their best. In fact, its not unusual for a family-of-record to relay that they aren’t comfortable with a vet’s recommendation for a prescription diet when it becomes necessary, even though they can appreciate that those options are there. Or, they want to feed a fresh, homemade diet or even a raw diet, though they aren’t getting the support they’d like from the vet team to do that. The position of the clinician is understandable, and so I always open my response with that. There are many caveats to going homemade or raw, though by searching internet, you’d not know that—there’s lots of unqualified support for pursuing it anyway. And, families need to understand the problems that they might face in doing so without an expert reviewing their pet’s individualized needs. 

Because it’s required that the primary or hospice vet be in the loop, I have happily referred families to the real professionals: veterinarians boarded in nutrition, veterinarians certified in TVCM, veterinarians with additional education and interest in assisting families with therapeutic diets and animal nutritionists (these professionals typically have MS or PhD level degrees). These professionals are able to, after reviewing a pet’s medical records, make their assessment and design a nutritional plan that is appropriate and safe for the pet’s needs. From homemade diets, fresh frozen and dehydrated options that are commercially available—and even raw—families can be matched with options that all involved can feel good about. 

I’m also very excited to report that if families ask their primary or hospice veterinarian, who might not be that comfortable making recommendations for these options, they’re usually happy to liaise with online resources like balance.it and Pet Diets—companies spearheaded and powered by veterinarians whose specialty is nutrition and designing individualized meal plans. 

If you’ve an interest in feeding your pet in a way that is aligned with your values and wishes and that serves your pet best, you deserve to have the best support possible to help make that happen—and that doesn’t come from armchair experts. 

With over 20 years of experience in pet care and the past 9 of those focused on animal hospice, Lorrie Shaw is a Certified Animal Hospice Practitioner and Certified Fear Free Professional. She is CXO of Telos Companion Animal Services, LLC and can be found at lorrieshaw.com.

Looking for a canine enrichment option that won’t be a foreign body risk but is still fun? Help is here

Canine enrichment is a topic I bring up not only during consultations, but throughout the pet’s lives that I’m tending. It’s vital in keeping dog’s happy, with its ability to stimulate the brain, engage the body and at times, use problem solving skills. It’s also a stress reliever. Enrichment can take many forms, can be employed at any age, and I’m deeply appreciating the notion that so many pet product companies have come up with novel designs for pets, especially dogs. 

Some of them have been designed for those who are power chewers—you know, those dogs who will routinely destroy and swallow commercially available toys. Sadly, a percentage of those dogs have or will land in an veterinary emergency hospital after ingesting a chunk of said toy and developing an obstruction. And so, families have no other option but to skip offering traditional toys, but what fun is that for them or the dog? 

I’ve stumbled on a workable and safe solution that any dog—no matter the telos, size or age—can safely enjoy, thanks to my brain going down a rabbit hole whilst working with an avian charge this past week. We professional often use fruits and vegetables to hollow out and stuff to create foraging opportunities for exotic birds, and I thought, ‘why not use this idea for dogs’? 

‘Tis the season for apples here in Michigan, and they can be used to craft a safe, inexpensive and healthy opportunity for dogs to have a chew party, when they might otherwise have to forgo that pleasure. I explain more in the video below. For more ideas on safe options for dogs, click here. 

With over 20 years of experience in pet care and the past 8 of those focused on animal hospice, Lorrie Shaw is a Certified Animal Hospice Practitioner and Certified Fear Free Professional. She is CXO of Telos Companion Animal Services, LLC and can be found at lorrieshaw.com.

Has ‘work-from-home’ influenced how we view and tend pet loss and grief?

A commonly-asked question is, how does one respond to people who say, Grieving over a pet? I mean, it’s just a dog… you can get another one?

I won’t go too far into the weeds with how comments like these lack sensitivity. I can say from my years in companioning families through their pet’s journey through hospice and end-of-life that most of the time, it’s hard for other people to be sensitive to situations they’re not familiar with, or find too emotionally-grueling to navigate. And so, the comments that land like a lead weight during an already brittle time erode what emotional and physical resources those grieving have left. 

 

We know that when people have space held for them to move through their grief, they can fare well. It’s when that disfranchised grief is minimized, ignored or is used to shame is when problems begin. And those responses—stressors in themselves—from others add to the trauma and emotional toil that is experienced. 

 

We find this is especially prevalent in one’s work life, a space that many of us occupy more than our home lives. And so it’s easy to see how impactful walking that tightrope can be both for the one that’s suffered a loss as well as their workmates. 

 

In my years of companioning those who’ve lost a pet and need extra support, I’ve advised that avoiding people who aren’t behaving as supportively as they’d like to be is a good option. The problem with that is it’s more of an ‘ugly coping’ tool, as George Bonanno calls it. Coping ugly can take shape in various ways, and consist of strategies/behaviors that we might otherwise deem unhealthy to help us cope with grief or trauma. In this case, it’s having to suck it up and sit with the offhanded comments or the platitudes that come out of another person’s mouth. It’s fine, now and then, and it's also an emotionally draining front line strategy. 

 

The additional advice I offer is that it’s perfectly fine to respond clearly and thoughtfully, with one’s boundaries fully intact: 

 

This is a very difficult time for me to navigate. I’m not sure you’re aware of it because maybe this uncharted territory for you. But your comments are unhelpful, so I’d appreciate your saying instead ‘I don’t understand any of this though I can see it’s affecting you tremendously’, and leave it at that, or at the least not remark on what’s happening at all.”

 

I have to say, though, I’ve had a thought getting traction in my head: I’ve been wondering if the increased opportunity of work-from-home in the past couple of years helped us be more aware and empathetic to others when it comes to grief? Seeing our co-workers’ pets on Zoom meetings over and over, does it make us more aware of how profoundly their deaths affect their guardians? 

 

I think so.

 

And though it’s fair to say that we’ve all gotten more savvy with Zoom in the way of being able to navigate the platform and others like it and tweaking our backgrounds and such, seeing those we interact with during our work time in their home environment albeit on the screen probably caused a lot more of us to ‘see people close up’, so to speak. More human, more who they are. Having some of that curtain pulled back, the one that normally obscures our home lives also means seeing family pets on the screen. 

 

More than one pet guardian has relayed how comical their colleagues thought it was that their dog barked upon hearing another Zoom participant’s dog bark in the background. Or, during a virtual meeting with a co-worker who they find frustrating, a client noted that upon seeing an adorable feline mug suddenly pop up on the screen, they were reminded that while challenging for them to deal with, they “are still that cat’s dad! It helped me remember that he might find me frustrating, too and he really seems to love his cat.”

 

I’ve also heard echoes of sentiments like, “…after Sammy died, all of my co-workers seemed to be genuinely clued in to how hard it was for me in those first days” or “one of my team members had been off for a few days, and they hadn’t known Eddie died…they piped up just before their last meeting of the day ended asking ‘…where’s your cat? He’s camera-shy, today!’ They’d no idea about Eddie, and understandably, were taken aback. They were so affected by the news.”

 

It’s clear that to some degree, those emotional barriers that were the norm previously are giving way. Plenty of us noted during the beginning of the pandemic that virtual meetings of every type made things feel artificial, less-connected. And as time went on, that eased into realizing that using Zoom and other platforms, for some at least, fostered a different environment. One where, because people had to pay closer attention to the other parties on their screen, they’ve also been able to view them with a new lens. What seems to have unfolded is an environment that’s more human, accepting, and naturally creates more space for others, especially with something that we all share—loss and grief—is concerned.

 

And so, will that momentum in being more sensitive to others during times when they’re experiencing a high emotional load because of their pet’s illnesses, decline or death continue to move in the right direction? I certainly hope so. But more importantly, I do think that will help make issues surrounding grief and loss less taboo and better equip our culture to understand how to support others who need it.

With over 20 years of experience in pet care and the past 8 of those focused on animal hospice, Lorrie Shaw is a Certified Animal Hospice Practitioner and Certified Fear Free Professional. She is CXO of Telos Companion Animal Services, LLC and can be found at lorrieshaw.com.