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.

Predictability, the right tools and simple rules promote a sense of safety for senior or infirm pets and their humans

One of the first things that I notice when meeting a family with an older pet, or one receiving palliative/hospice care, are the ways that the humans have implemented ideas to address the animal's changing needs. It's typically a combination of things designed to enhance mobility, prevent any falls and comfortable rest. I'm always happy to see the creative and thoughtful strategies that families use to accommodate their pets with time-tested tricks, and even some terrific new products on the market.

Safety first, is the mantra when it comes to our pets, but something that is too often overlooked—and vital nonetheless—is the need to ensure the safety of the persons handling and interacting with the pet. I’m happy to say that in all of my years caring for pets professionally, especially geriatric companion animals and those in end-of-life, I’ve not been bitten. But it’s not luck: I’ve employed safe rules of engagement.

The truth is that animals that are living with pain (numbers that are often underestimated, in my experience), those that are not feeling well or have issues with mobility quite often are apprehensive about interacting with us, especially when we need to assist them in some way. Chronic pain wears on animals just as it does humans, both physically and mentally. It doesn't feel good, and the prospect of being in more discomfort or not having the autonomy to move independently and at a pace they can manage is daunting.  The same holds true for pets with diminished vision or hearing; having either or both of those senses dulled or expired impacts the way that they might be able to respond if approached in away that is incompatible with what they're comfortable with. And when that's the case, pets react in really the only ways they can: they give a clear warning when put in situation that's challenging—usually with a look, a growl, even a quick snap—or in a worst case scenario, yes, a bite. For that reason, it seems important to reiterate the need to interact with our pets in a safe, mindful manner always.

Additionally, the assistance the we give is physical in nature, and no matter the size of the pet, keeping our bodies safe from injury (both from bites and from lifting/assisting) is imperative.

The basics

It seems important to begin by saying that understanding where a pet's comfort zone is, what causes them tension or unease is a great place to begin to both be most helpful to them, and for us to stay safe.

Be aware of proper lifting and transferring techniques. Using tools like harnesses and slings for dogs can help facilitate ease of assistance, provide stability. You can create a sling from re-purposed materials, but harnesses like the RuffWear WebMaster and the Help-Em Up are especially great because since they have handles attached, one need not have physical contact with the pet. This is a plus, as many arthritic dogs can be a little guarded about being touched, even a helpful way.

Create a safe environment for pets with diminishing mobility. This might mean moving dog beds (preferably orthopedic!) to a main floor area so that they are not only easily accessible but so pets need not use stairs. By placing rubber-backed area rugs on non-carpeted floors, pets can have sure footing on these surfaces. Consider adding baby gates to limit access to areas like basement stairs, a second story, or other areas where a pet has trouble negotiating movement. By implementing these strategies, we reduce the necessity of having to help a pet up from a fall because they've lost their footing, which is an area of less-than-ideal interactions that gets overlooked.

Understand how changes in cognition, hearing or vision can affect how a pet responds in various situations. A pet's senses can be dulled with age, so it's easy to imagine how that affects their perception of what's happening around them. This is especially important when people and other animals are close by. Giving a pet that's hard-of-hearing a little warning that you’re approaching with a wave of a hand, a click of a light or by not approaching them from a direction where they're not looking is mindful.

Pets with visual impairments benefit from an audible heads-up, like a verbal cue or a quick whistle before being approached.

It's also important to remember that some medications can leave pets a little sleepy, so that can affect their ability to respond.

Changes in cognition can affect how a pet may process being touched and/or approached.

In my experience, geriatric pets can be quite fuzzy-headed upon waking, and it can last for a while longer on some days, so they always need extra time to get rid of the cobwebs. Speaking of sleeping, it goes without saying that approaching a dozing pet too closely or touching them carelessly isn’t wise, but this is especially true with older pets or those traversing illnesses and end-of-life. When trying to rouse one of my charges, I’ll often give a couple of raps on the wall where they are sleeping and call their name calmly but audibly.

Other considerations in safety

The younger members of a family aren't as sophisticated about recognizing signs of uneasiness or stress in pets of any age, and so it’s vital that there is open conversation with children who are in the midst of family pets about using extra-special care when around older or infirm pets. Click here for a great source of info by Dr. Sophia Yin.

As a caregiver, I stress these strategies to clients as we talk about my caring for their most vulnerable family members not only for their safety, but mine. Though I adhere to low-stress interaction techniques and those that don't promote fear, as one who is new in the pet's life, they're often less-than-comfortable with my needing to physically handle them in ways that they might not feel so much so about with a trusted member of their tribe.

By implementing these rules of promoting safety and favorable interaction with each human that comes into contact with a pet with these special needs, there's a sense of predictability, and that is critical for their overall well-being.

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.