Wednesday, November 15, 2017

Picking battles, understanding limits while a pet is in hospice can be transformative

Recently, I was meeting with a family to get up to speed on their dog’s hospice care plan. They had lost another dog, Sal -- one that they had adopted well into his senior years -- only a couple of years earlier, and that experience was still quite fresh in their memory. In the time since their sweet boy, Timo, had developed a life-limiting illness, we’ve set time aside to talk about the changes that have been occurring, how the family is feeling about what’s happening, how well they feel they’re all managing and bouncing ideas around about comfort care and safety.

“I really wish that I could do more for Timo,” said my client, someone who I might add isn’t shy about administering care, no matter how challenging or messy the task is.

“I get the feeling that you mean a little more than what you’re saying,” I replied.

This, after getting the update on my charge’s updated prescription regimen and hearing how he gave the clear indication that he wouldn’t be accepting of acupuncture. He also doesn’t tolerate taking one of his medications well, so, as with many hospice pets, we give the medications he needs in order of importance, and administer what he’ll reasonably allow and revisit what he won’t a little while later in hopes that we’re successful -- basically, picking our battles.

“Yes,” she went on to say, with a big sigh. “I just wish I could give him all of the medications everyday. Sal was so good about it; Timo is a different story, and he’s not faring as well as he could.”

One thing that I’m certain of in my work is that navigating animal hospice isn’t routine, nor perfect.

There’s the notion of having ideal days, rough days, really good days, great days, even, but it’s never perfect. Having that realization come at you when you’re hospicing a pet, especially when you’ve tended to another so recently can make for a daunting journey. And when things had gone well in one’s previous experiences with animal hospice, it can conjure up some complicated, unexpected feelings -- including frustration and guilt -- emotions that we when we need to free from when trying to focus on providing that level of care.

The truth is that we need our pet’s cooperation, their permission, really, to carry out a hospice care plan, among other things.

Some companion animals are extremely easy going, like Sal was, others not as much. It seems important to note that no two pets are alike, nor are their disease trajectories, even if they seem similar. Case in point: two like-aged cats with renal insufficiency can fare differently based on any additional diagnoses that they have, like diabetes, hyperthyroidism -- not to mention their personalities. A medical issue seems easy enough to contend with, right? It’s there, it is what it is, no wrestling with it. It’s more tangible, rigid, cut and dry. But a pet’s willingness to consent or cooperate with allowing care, veterinary exams, taking medication requires flexibility; we can try and work with that, we can cajole them.

Or can we?

Well, most of the time. Sometimes. In some cases, never. And there’s the rub.

Sure, we can be creative with compounded medications and with disguising pills and capsules, and that works well, but sometimes, we just need to honor what our pet is telling us and back off a bit, maybe try again later. Perhaps the pet prefers someone else to handle that particular duty.

We can forgo some treatments, even supportive care like subcutaneous fluids, and try other, less effective strategies that a pet will accept or that we’re able to manage.

We can, if it’s too stressful for the pet or the humans, go with a house call veterinarian instead of going to a vet clinic.

With some pets, hospicing them -- nor treating them reliably for any medical condition -- isn’t an option at all because they won’t allow anyone to handle them, something that becomes more necessary as things progress. We can only do what they will accept, and what we’re able.

Something else to think about is how we as family members might be different in handling the duties of providing palliation or hospice care the second or third time around. We’re not the same person as before. It’s important to ask ourselves: Are we as physically able to manage it? Do we have the time needed to devote to it? Mentally, do we feel equipped? Are the financial resources in place? Are we trying to manage the care of a human loved one who needs it right now as well? Is everyone in the household on board with managing the plan?

That’s only part of what affects how a palliative and hospice care plan can be seen through. Ensuring that the pet and the humans at the core are feeling honored and supported by the professionals involved (veterinarians, pet sitters and even a pet’s trainer or behaviorist) is also vital through the process. So is understanding that circumstances can change at any time and affect the way that the plan is carried out. I’ve seen time and time again that much of the strife that is felt by families comes with the ever-changing landscape that comes before a pet dies, and it can be amplified by comparing this experience with previous ones, especially if the latter was one that was more manageable.

I’m not going to say don’t feel guilty or don’t let the fact that your pet isn’t accepting of treatment upset you, because that’s our nature to have emotions like that in those situations. What I will offer is this: give yourself a moment to take a step back along with a deep breath, and understand that you are doing the very best that you can on any given day with the resources that you have and what your companion animal will allow. You might be surprised that in giving yourself the permission, the courage to do that, you can transform this time of life with your pet.

Lorrie Shaw is owner of Professional Pet Sitting, where she specializes in ancillary pet palliative and pet hospice care support. She is also a Certified Pet Loss and Grief Companion and a member of The Association for Pet Loss and Bereavement as well as the International Association of Animal Hospice and Palliative Care and Pet Sitter International. She tweets at @psa2.

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