Monday, September 29, 2014

End of Life Discussion

We posted this as well on out sister blog (premium4dogs)

From the September 2014 Life's Abundance Newsletter:

With advances in veterinary medicine in the past 30 years, we now have more tools than ever before to treat disease. As a consequence, dogs and cats are living longer, which means plenty of visits to the vet’s office.

As long as there are no major medical issues to contend with – just wellness checks and treatments for the occasional injury or illness – there’s a pretty low level risk of tension between a vet and a pet parent. But when things go badly, such as with a terminal diagnosis, that risk can escalate dramatically.

Pet parents can often be so uncomfortable thinking about end-of-life care, much less talking it through, that they become defensive when discussing treatments for a terminally ill companion animal. I think it’s because veterinarians are trained to cure disease, and that’s our primary focus. When you present us with a problem, our chief goal is to find a solution. Not every pet parent, however, has the desire or the means to fight terminal conditions to the fullest extent.

The advances in veterinary medicine come with a high price tag, and while aggressive therapies may prolong life, they can prove overly stressful to pet kids and parents alike. If anything prevents open, honest communications between veterinarians and pet parents, it only makes it harder on your dog or cat. You and your vet have a shared goal of caring and comforting a beloved companion animal in a tough spot, so try to see your relationship as a partnership. Some pet parents can have difficulty expressing an unwillingness to pursue aggressive treatment. Some fear appearing callous or uncaring, while others may be embarrassed by financial constraints. It’s our job as veterinarians to provide all the relevant information, to empower you to make the right decision for your set of circumstances.

The last thing you want is any friction between you and your vet, especially when a terminal condition is involved. Such a diagnosis will likely mean loads of interaction, sometimes several times per day. I mean, these are literally life-and-death decisions.

There are some things to keep in mind when discussing the best course of action with your vet, in order to be the best possible advocate for your pet kid during this difficult phase of life.

 Questions & Second Opinions are Good Things

If concerns about quality of life outweigh all other considerations, make sure your veterinarian understands that fact. The benefits and potential disadvantages of each treatment should be crystal clear to you. After the initial diagnosis, write down a list of medical care questions. Reading the blogs of other pet parents who've dealt with similar issues could prove helpful if you don’t know what to ask or where to begin. Hospice care is a relative newcomer to the field of veterinary medicine. In fact, some clinics may not even have a protocol for this option. Even if your vet doesn’t offer these services, they will know who does in your area. If you grow uncomfortable with the options being given to you, don’t be intimidated by, or even feel guilty about seeking a second opinion. It isn't rude or disloyal … it’s an effective method of information gathering.

 Don’t Rush Decisions 

In a typical scenario, testing will yield a diagnosis fairly quickly. When the assessment is presented, be sure to take notes. Trust me, when bad news comes it can have a negative effect on your memory. If the prognosis is poor, but the condition is not an emergency, take all relevant info home and sleep on it for the night. For many, a dire diagnosis comes as quite a shock. Give yourself time to process the information. Many find that 24 hours to mull over and research a condition helps them have a more objective, and less emotionally charged, follow-up conversation.

 Palliative Care is a Valid Treatment Option

Palliative care is the logical choice if the decision’s been made not to pursue restorative treatment for a likely terminal illness. It should not be viewed as giving up, it’s just another valid care option. With extra hydration, pain medication, nausea prevention, and more, it’s a way to ensure a peaceful and humane end of life. The duration is entirely dependent upon the advancement of disease. Palliative plans can last weeks, days or hours, giving people time to say their goodbyes while allowing pet kids to pass naturally and as close to pain-free as possible.

 Be Clear about Your Limits from the Beginning

It is your veterinarian’s job to discuss all of the options available for treatment. A vet may even grade the treatments as ‘good’, ‘better’ or best’. We are trained not to make any assumptions about what measures a pet parent is willing to take. Try to have an open mind about the treatment options. For example, to many, amputation sounds like a devastating prospect. However, many pets cope quite well with the loss of a limb. Chemotherapy can be quite unpleasant for people, but some pet kids don’t experience nausea and they rarely lose their hair. If your vet proposes a treatment option that you find unacceptable, speak up! Tell them what you are willing and unwilling to do. Articulating your preferences will help veterinary care providers tailor a treatment plan according to your needs.

Nothing will make it less painful, but the more we learn about end-of-life care for companion animals, the better equipped we’ll be to handle these situations. Having the confidence that your vet is a compassionate partner for every stage of your pet kid’s life could make a huge difference

Thank you for all you do to make the world a better place for companion animals.

 Dr Jane Bicks 

Cat Behavior Tips

Courtesy of the Life's Abundance September Newsletter:

Dr. Sarah, staff veterinarian goes over different cat behavior, why, what you can do about it and awesome ways to make homemade toys for your favorite feline (s)!!!