When I first got the phone call from Tarah about her cat Ruby, I was not sure what I was going to be able to do to help. On paper, Ruby was really only a candidate for one thing: euthanasia. She was 18 years old and had not one, but two types of cancer, including one which affected her tongue. She was also hyperthyroid and her kidneys were no longer functioning at full capacity. At the time Tarah contacted me, Ruby was becoming lethargic and was no longer eating or drinking very much.
You might think Tarah contacted me because she wanted to schedule euthanasia for Ruby. Tarah’s partner, Jessica, was more than ready for this. As a human healthcare provider, she had seen enough pain and suffering. However, Tarah was not yet prepared to say goodbye. Ruby was a cat Tarah had shared with her previous partner who had passed away, making it even more difficult to face the idea of life without her. In addition, Tarah’s last experience with euthanasia had been many years ago when she felt her vet at the time had put pressure on her to make the decision. Tarah wanted to make sure that she was not making such an irrevocable decision too soon. At the same time, she did not want to see her beloved Ruby in distress. So no, Tarah was not seeking euthanasia for Ruby, she was seeking hospice.
“Hospice for animals? What exactly is that?” you might ask. Animal hospice is a relatively new but rapidly growing field in veterinary medicine. It is closely modeled after human hospice and aims to meet the needs of a pet faced with terminal illness or a permanently debilitating condition until natural death occurs or euthanasia is chosen. While palliative care is an integral part of hospice, hospice is not just palliative care. It is family centered, rather than disease centered. It is care provided to comfort, rather than to cure. It is holistic in the sense that it includes treatment of the whole pet and the entire family, considering physical, mental and social factors, rather than just symptoms of disease. The goal is to provide pain control and physical comfort to the pet as well as educational and emotional support for the family.
So how could I apply the hospice concept to help Ruby and her family? Well, when I finally met Ruby in her home, I found a spunky little cat still very much interested in life. She approached me to ask for (actually demand) some love, purred when petted, then wandered over to curl up in a favorite spot nearby. In reviewing her history, I learned her internist had sent a nurse to their home the previous day to administer fluids and a dose of pain medication. Tarah and Jessica felt she seemed more comfortable and even ate a bit of food after this treatment. I thought if we could keep Ruby hydrated and get her some consistent pain control, she might feel much better all around. We instituted a regimen of fluids under the skin (subcutaneous), as well as pain medication they could administer easily on her gums. In response to this Ruby began to perk up, feel more relaxed and eat more consistently. To help Tarah and Jessica, I provided a Quality of Life Scale to empower them to assess Ruby at home. We also discussed how Ruby’s disease might progress. Tarah and I kept in regular communication by phone, email and text between visits, so I could help support them through the decision making process and adjust treatment as needed.
I visited Ruby several more times in the few weeks that followed. She remained comfortable and active and continued to visit her food bowl regularly. Tarah eventually did make the decision to say goodbye to Ruby. She never let her get to the point of being in distress. While it was still difficult, she had had some extra time to spend with Ruby, and was able to make the decision with peace and a clear heart.
Animal hospice is not for all families. It can sometimes require round-the-clock care by family members and friends. Providing that care can be emotionally and physically draining. However, for those families not wanting aggressive therapies and yet not ready for euthanasia, it can be a very special way to honor the human-animal bond, create a period of closure and help give everyone involved the support to say goodbye. To learn more about animal hospice visit any of the following links:
The Quality of Life Scale: http://vetsocialwork.utk.edu/docs/Quality%20of%20Life.pdf
The International Association for Animal Hospice and Palliative Care: https://www.iaahpc.org
The International Association for Pet Loss and Bereavement: http://www.aplb.org
Always feel free to contact Dr. Ravina directly with any questions at firstname.lastname@example.org (831) 708-9588.
Dr. Ravina's hospice practice website is http://www.peacefulpawsvet.net.
Blog Post Author:
Gabrielle Ravina, DVM