Tuesday, January 1, 2019

Trigger-stacking and other causes of aggression in geriatric pets can move the conversation toward euthanasia

"Let's schedule a consultation well before any trip you've in mind to meet and get a feel for whether or not we're all a fit," I always implore once a family and I have a chance to make that initial connection by email or phone. 

They can also be assured that I'll be asking a lot of questions about their pet's health and behavior, as well as a history on both had how they've changed as they've aged or how their co-morbidities have progressed. I also do periodic re-assessments with my existing families with pets in fragile health or advanced age.

Because of my experience, it's not uncommon for families with pets with special needs—usually geriatric pets—because of their health and behavioral considerations to reach out for help with their care. It could be that they'll be traveling or need a hand while they're at work to tend to little or big things that contribute to the pet's comfort and well-being, not to mention the family's peace of mind.

You'll notice that I noted health and behavioral considerations. Those two things are very much united when we're talking about geriatric pets receiving palliative or hospice care. In fact, they're criteria, or need to be, when families receive a life limiting diagnosis for their pet, or when age-related decline has necessitated conversations about how to best help them. We have a lot of options for treating disease, or crafting a palliative or hospice care plan—but how that is carried out is another matter. Not only does the family need to be able to manage it, but so does the pet. I recall saying on one podcast that I guested on, "...we need the pet's permission and cooperation... they need choice [on whether or not to participate]." 

Pets are great communicators. And in my professional training, which includes a designation of dog bite safety educator, I've learned to home in on what a pet is telling me or those around them. A pet's sensory deficits (like vision and/or hearing), physical decline, pain level, their overall feeling on a given day and any cognitive dysfunction can impact their ability to manage tolerating a treatment plan and being interacted with to have it in place. The same is true if a pet is touch averse or has behavioral issues. I spend time talking with families about all of this, as well as how their absence alone can impact the pet's ability to cope, not to mention being in my care for any length of time. 

As I said, when doing a consultation, I have a lot of questions about a pet. I ask about their care plan including medications, and things like how easily they rest and eat among other things. For those of a certain age or in fragile health, I request a full health assessment be done by their primary veterinarian. It's vital that the pet's health be stable enough to be in my care. While all of that is the criteria that I use on my end, I also assess the companion animal from a behavioral and emotional standpoint. 

I'm not ashamed to say that there countless families that hear me say, 'I don't think that your pet will do well in my care, or in your absence at all' or 'I get the feeling that your dog could manage your being away for a long weekend, but ten days... no. That's too long.' I always offer facts to support my case to advocate for the pet and myself, and I stick to my guns.

The truth is, when a pet enters the phase of palliative or hospice care, it's not only about daily management of a medical treatment plan. It's about them having stability, predictability, and routine and I'll assert that is the core foundation of it all. Their emotional and behavioral well-being depends on that. So does my ability to promote safe interactions between me and the pet, something that can be more challenging as a pet moves through this phase of life.

And sometimes, I'm not confident that safe interactions between myself and the pet will be possible, and it is likely to things that one might typically disregard. It can because the kinds of interactions that the pet requires to stay adherent to the treatment plan and feeling good, like being medicated, make them uneasy. Hygiene and needing help with that can be problematic for a pet. If a dog needs help physically getting around or help up from their bed or assistance getting up if their legs give out when they're walking (even with a sling) because of the all-too-common hind limb weakness, that can put me in a dangerous situation. Being out of routine and in the care of a less-familiar person can contribute, just like a family's absence can. All of these scenarios can stress the pet and lead to a nip or a serious bite. I clearly and compassionately articulate that, and give specific details why, because it's more common than not that I'm seeing the pet is demonstrating that they are having trouble with trusted and known family members performing those tasks, too.

The stuff that I've talked about already is a good example of what we in the pet care and training industry refer to as 'trigger-stacking'. Though, in this phase of life new triggers are often revealed simply because the pet's health needs require more frequent interactions and handling.  

This all brings me to a topic that I'm asked to weigh in on periodically: whether or not humane euthanasia should be considered for a pet that is experiencing behavioral changes, namely aggression, that make for a very slippery slope when it comes to their well-being and safety, and the humans around them. It's hard to ignore how even the most seemingly benign interactions that a pet requires can become triggers for them. In some cases, the techniques used to navigate through interactions can be modified to suit a pet's new boundaries, but when that's not possible or a pet's stress and anxiety can not be assuaged, or a bite occurs, exploring the decision of humane euthanasia becomes a very real thing for families. 

Though I urge families to discuss this with their veterinarian—the only one who can guide them through this decision and process—I offer some perspective. For anyone who has done it or done their best to avoid it, it's hard enough to have that 'bigger conversation' as I call it, with a veterinarian about euthanasia when one is considering a pet's physical and medical decline and their inability to manage physically and emotionally (this goes for the humans too). And introduce the topic because there's a question that a behavioral element affects anyone's safety, it completely changes the landscape of the situation. I assure you that the emotions that a family struggles with regarding humane euthanasia are ten-fold when the conversation is broached because of a question of a pet's behavioral stability, and oh, do they have a lasting effect. 

The truth is that in most cases, I've seen that behavioral changes, yes, even aggression, are often heavily influenced by factors like a pet's ongoing pain or other factors. There are diseases that are known to affect a pet's behavior (like diabetes, hyperthyroidism and hypothyroidism, the latter often linked to laryngeal paralysis and accompanying hind limb weakness in dogs), and even Canine or Feline Cognitive Dysfunction. These are very much medical conditions, and can in themselves contribute to trigger-stacking. And as time goes by, medical conditions of any kind can become less manageable, especially if a pet's ability to participate in their prescribed treatment plans, including taking medication, becomes more difficult for them.

I say all of this not in an effort to minimize how much a pet's behavioral stability can impact the decision about whether euthanasia needs to be a part of a conversation. I do so to highlight the weight of how medical conditions—diagnosed or not—influence a pet's overall ability to cope, physically, emotionally and most of all, behaviorally, even to the point of aggression. And in looking at a situation from this vantage point, it helps to see that perhaps the decision to euthanize is less about viewing a pet as an aggressive animal who's behavior is jeopardizing the well-being of themselves or others, but how the progression of medical issues has impacted their ability to cope and be the calm, loving pet they've always been. In any case, it's important that we are not expecting more of a pet than they are willing or able to give, and to respect their boundaries, especially when they move the proverbial line that tells us where they are. That's the greatest show of compassion that we can give them, and ourselves.

Lorrie Shaw is a Certified Professional Pet Sitter, Certified Pet Loss and Grief Companion, and owner of Professional Pet Sitting, where she specializes in ancillary pet palliative and pet hospice care. She's also 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 Sitters International, Pet Professional Guild, International Association of Animal Behavior Consultants (supporting member) and Ann Arbor Area Pet Sitters. Lorrie can be found at lorrieshaw.com. She tweets at @psa2.

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