When my 14-year-old Sheltie, Drew, was diagnosed with kidney failure, my veterinarian offered me something that wasn't an option when I started writing about pets a couple decades ago: hospice.
He encouraged me to manage Drew's terminal disease with daily IV fluids given at home and with a diet geared toward reducing strain on my dog's failing organs. That was a few weeks ago, and now Drew's kidneys are functioning well and he looks and acts years younger than he is. No one who meets him would guess he may have only weeks to live.
That quality of life is what hospice is all about, and the trend is catching on, according to advocates.
"The path to death is detoured a bit," says Dr. Robin Downing of the Windsor Veterinary Clinic and the Downing Center for Animal Pain Management. An internationally known expert in pain management, Downing is one of a handful of strong advocates for palliative care for pets, the practice of keeping animals happy and comfortable in their final days, weeks and months.
"We needed to find a way to help these animals live until they died," Downing says. "That's what hospice is about: living fully."
Since the 1990s, the introduction of a series of effective nonsteroidal anti-inflammatory drugs (NSAIDs such as Rimadyl, Metacam and Deramaxx), along with the increased acceptance and use of complementary pain medications, has changed veterinary practice.
Previously, many veterinarians had avoided pain control for animals after surgery. The consensus view was that if moving hurt, a pet would be more likely to be still while healing. That thinking was changed by research showing that animals heal more quickly when pain is controlled.
For veterinarians such as Downing, these improvements in pain management made it clear that in some cases, they could also ease the suffering for animals for whom they could do little else.
Veterinary oncologist and hospice advocate Dr. Alice Villalobos of the Animal Oncology Consultation Service in Woodland Hills notes that this idea ran counter to what veterinarians had been taught for decades.
"We were taught to offer euthanasia when a pet started faltering, and we have all been educated to focus on care for the pet's life stages," she says. "But end-of-life care was not included, and it is a life stage."
Villalobos says that only a small percentage of the nation's veterinarians offer end-of-life care, but there are signs that this is beginning to change. Indications of the increased interest include the first-ever pet hospice symposium at the UC Davis School of Veterinary Medicine in 2008, followed by the founding of the International Association for Animal Hospice and Palliative Care the following year. The American Veterinary Medical Association recently revised its guidelines to emphasize that "veterinarians who do not offer hospice services should be prepared to refer clients to a veterinarian who does."
Although advances in veterinary pain management have helped propel the idea of hospice, that's not all there is to palliative care. Other means of easing an animal's suffering may include regular subcutaneous fluids to improve hydration such as I provide to my dog oxygen therapy and assistance devices such as slings to support weakened hind ends.
Hospice help may also include physical and massage therapy as well as advice: urging pet owners to cover slippery floors with rugs for better traction, or finding or developing diets that support a patient who may not want to eat. Complementary and alternative veterinary medicine, such as acupuncture, can be part of the package as well as it is for Drew.
The final aspect of veterinary hospice is recognizing when it's time to say goodbye. And while I'm certainly not looking forward to it, I know I'll be better prepared for the end after the extra time together my dog and I have both enjoyed.