Monday, September 17, 2018

Self-advocacy is just one strategy to hurdle being overwhelmed by a sick pet's treatment plan

One of the ways that I spend my time working in the field is by helping families out with specialty care—things like subcutaneous (sub-q) fluids, esophagostomy (e-tube) feeding, giving injections, things like that. It can take some of the load off of the family when they need to travel, or when work or other obligations make keeping up with the care regimen prohibitive. I also coach families on ways to get comfortable with performing the tasks, best practices for keeping things sterile and having ensuring safe interactions with their pet during the tasks, as well as what to look out for as far as signs of trouble. I make a point of going over the veterinarian's written treatment plan with the family to try and detect any trouble areas they might have, and to answer any questions they are reluctant to ask the vet or their staff. 

It’s not lost on me that it's not easy to perform this kind of care when the pet is your own, especially when you've no experience and you're worried about pushing slurried food with an oral syringe into the tube that's been surgically placed into the pet's neck. Or when you need to try and get a minimum of 100 mL of fluid into your cat and you're tired and frustrated and can't seem to get the needle into them just right or you've poked yourself instead. If you've ever embarked on a newly-diagnosed pet's treatment regimen for diabetes, I don't need to mention how overwhelming that can feel. There are days or weeks where things are really tough, especially in the beginning. (It gets easier though, I promise!)

It's really a challenge if you're ruminating on your schedule for the week and wondering how you're going to manage Tuesday's tube feeding schedule or on Thursday and Friday you have to work double shifts and there's no way you'll be able to get the sub-q's done. Maybe you've got a needle phobia and having to give your pet injections is giving you some serious panic attacks that you already have difficulty managing—but some days are easier than others. Let's not forget the crises that come up with loved ones that need your attention, time and mental bandwidth.

I've heard these stories a lot. 

I've also been witness to those seemingly-genius light bulb moments of Why don't I just increase the amount on some days to compensate for what I can't manage on others? and I of course counsel appropriately. Sometimes I don't get the opportunity to hear that beforehand and a pet owner just goes for it. What's the harm?

(On the other side of the coin, in some cases, I hear, More is better, right? The rationale that if the vet recommended this regimen, and the pet is doing well, then doing more must be perfectly fine: if it's worth doing, it's worth overdoing.)

The results of this kind of tweaking can seriously complicate the diagnosis that the treatment plan it's meant to address. Doubling up on the volume of fluid that you're supposed to administer subcutaneously can result in things like fluid buildup in chest, something that cats with existing heart conditions—diagnosed or not—are at an even higher risk for. Trying to tube feed a pet too much or doing so too quickly can stress them out tremendously, and can cause or exacerbate any nausea. The efforts are often wasted since the pet will likely vomit either from the overload of food or being nauseated. And injections, especially when it comes to insulin, well, that can be a hot mess when adding extra doses. 

Though one of the details that I touch on when providing support with these types of specialty care plans—sticking with the doctor's treatment plan as it's laid out and to call the clinician with any questions—I also realize that it can be difficult, for the reasons I pointed out earlier. I find that often, families get home with their pet, a bag full of supplies and a discharge report and quickly go from feeling grateful that their pet can be treated for something and I've got this! to being overwhelmed and feeling incapably alone, especially when considering a work schedule or their own anxiety issues. Sometimes hiring the services of a professional like me can easily fill in those gaps and provide the support that's needed. But for some, they may not have access to that kind of help. 

If at any point you feel like you'll not be able to maintain any treatment regimen, no matter how simple, never be reluctant to relay that to the vet. Whether you're hearing what that plan is for the first time while face-to-face with the doctor, as you're fixing to leave the facility, or at home and giving things a solid go, if you're not able to manage things, please speak up. Vets understand and often are able to craft an alternative plan or regimen that you can stick to—or they can recommend a professional that is experienced in this area and can lend a hand at home. I know that it's easy to nod your head in agreement and say that you are clear on everything when a vet is reviewing the plan at the clinic or emergency hospital. It can be an intimidating space. The fear of being shamed or judged because you're not clear on things or not feeling confident about how you'll care for your pet is only second to wondering how you'll afford the bill. I get that. 

It can be tempting to double up on medications or sessions of sub-q fluids or tube feedings or even skip them repeatedly. But as I urge my families: forgo that idea to deviate from the doctor's directives and, never, ever be intimidated by speaking up about things that you don't feel are manageable with your pet's treatment plan for one reason or another, or to ask questions that matter to you. It's easy to find yourself in the weeds and you wouldn't be the first to be there. By advocating for yourself, you'll empower yourself to carry out what's necessary in a treatment plan as well as helping your vet to do their job and most importantly, your pet will feel better faster.

Lorrie Shaw, CPPS, CPLGC is owner of Professional Pet Sitting, where she specializes in ancillary pet palliative and pet hospice care. She's a member of Doggone Safe (where she completed the Speak Dog Certificate Program), as well as the International Association of Animal Hospice and Palliative Care, Pet Sitter International and Pet Professional Guild. She tweets at @psa2.

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