Welcome

December 16, 2011 § Leave a comment

As we realize our pet is getting older, we know that someday we will have to say goodbye.  It becomes hard to think about losing our pets, In fact,we often try very hard not to think about it.  But as pet owners, we owe it to our pets to look out for their best interests, and planning for the final stage of their lives is as important, maybe more important, than any other stage of life.

This blog is dedicated to exploring the end of life issues that are most important:
– Keeping your elderly pet comfortable
– Understanding the emotional journey of grief and decision making
– Planning how you want to say goodbye.

It’s about honoring the relationship we have with our pets.  I’d love your feedback and welcome sharing that might help others through this difficult process.

Veterinary Technicians – The Angels of Veterinary Medicine

October 14, 2012 § Leave a comment

The best way I know to make connections with strangers is to tell them I’m a veterinarian.  I get “ohs” and “ahs” and stories about pets – present and past.  It makes me feel special.

But I know that in veterinary medicine the hidden angels are our staff members – especially the veterinary technicians – that work in every veterinary clinic largely behind the scenes.  And this week is their week –  Oct 14th to the 20th.

Technicians are the nurses of veterinary medicine.  They are the ones that keep a practice humming and the doctors on schedule.  From the time your pet enters the hospital to the moment they leave, you can be sure the veterinary technicians are taking special care of your companion.  They work weekends and evenings, even overnights at the 24-hour facilities.  They often pet-sit to help make ends meet and most have many pets that were in need of a special home.

So  this week and every week, show your appreciation with a big smile or an extra thank you.  They don’t do the job for the money or the recognition.  They do it because they love helping animals heal.

Thanks to all of the veterinary technicians that make our lives as veterinarians so much better!

What is “Quality of Life” for a Dog?

October 2, 2012 § 1 Comment

When you think the word “Dog”, what image comes to mind?

In my minds eye,
I see a verb,
an action word
,
a creature in motion
.

Running, digging, crouching, sniffing, wagging – dogs hold such joy in their hearts.  Expressing that exuberance in activity and motion is a big part of who they are.

When I talk to clients about quality of life indicators in their older dogs, of course we  talk about mobility, pain control, appetite, elimination habits and other biological functions.  But quality of life also involves a dog’s spirit – the behaviors and activities that create the special bond we have with our canine companions and the daily adventure that is a dog’s life.

Can she still spend quality time with her people? Does she still want to?  Where does she sleep?  What happens when you go on family outings?

After a decade or two of being house trained, is he able to choose what instinct and habit tell her is the right & dignified place to eliminate.

What are the things he’s always loved to do?  Does he still enjoy doing them?  What about those people or noises that always gets her riled up?  Does a knock on the door still mean an opportunity to alert and protect?

The answers to these questions don’t necessarily determine whether or not it’s time to give up, but it may suggest we owe it to our dog to look for ways to improve that quality of life.  We can be creative to find ways to play within your dog’s limitations and adjust routines to accommodate.  We may want to consider pharmaceutical or alternative therapies to recover some mobility or cognitive health.

We are our dog’s keepers and they give so much to us in return.  As they age, we owe it to them to help maintain the quality of their life in the final stage of life to ensure that they are able to still be a dog, a creature in motion.

Being the Person Your Dog Thinks You Are

May 9, 2012 § 2 Comments

To fight off worry about the future or regret about the past, I actively look for ways to live in the moment – when I get it right, it’s an incredibly peaceful feeling.  I’m closest to that state of being when I am interacting with animals and it’s one of the reasons I became a veterinarian, committed to a vocation that celebrates that interaction we have with our pets – the human-animal bond.

I grew up in a household full of animals, but my first dog, Missy, was a birthday present when I turned eight – she was a beagle, basset, terrier mix that my parents found in the classifieds.  She was my best friend and taught me so much about compassion and love, fun and 0vercoming fear.  She was there for me through the most difficult years of my life.  She died while I was in college and when I think back now, I almost don’t remember my childhood before her.  I’ve had many other dogs and cats and other pets that I loved dearly, but my first dog will always hold a special place in my heart.

I saw one of my favorite sayings on a t-shirt the other day: Be The Person Your Dog Thinks You Are.”   What a worthy goal!  The relationships we have with animals truly are opportunities to learn new ways of living and connecting with people.  I am a better human being because of the animals in my life.  Both our dog Guinness and cat Pixel compel me to practice behaviors that help me to live a better life:

  • I slow down more often and live in the moment – As I scratch Pixel’s ear and feel her purring contentment, I’m fully present.  On walks with Guinness, I take time to breathe, feeling the freshness in the morning air.  At night I am forced off the couch to marvel at the miracle of the night sky in the quiet of the evening.
  • I see and experience what unconditional love looks like (from the dog, at least.)  Although relationships with fellow humans are inherently more complex, I can then practice that non-judgmental, forgiving kind of love in my other relationships.
  • In the company of my dog, I play more often; I laugh at his antics and share smiles with so many more strangers.  Together we are more curious that I would be alone.
  • Animals teach me to be more patient with them and myself and help me practice being “close enough”.  I have to accept that my house, my schedule, my life may have some imperfections (ex. dog hair) and that it really doesn’t matter all that much.

The healing and mutually beneficial human-animal bond has existed for thousands of years.  According to the CDC, pets can decrease your blood pressure, lower your cholesterol and Being the Person Your Dog Thinks You Arerelieve feelings of loneliness.  Pets can also help us increase our exercise, outdoor activities, and socialization.  But even without scientific data every pet owner knows intuitively that having animals in our lives contributes to our quality of life.

Today, I will try to be the person my dog thinks I am.

Silent Killer in Older Cats – Hypertension

April 2, 2012 § Leave a comment

Most people know that high blood pressure, or hypertension, in humans increases the risk of heart disease and stroke and can be present for long periods of time with no outward signs.  Would you be surprised to know it is also “the silent killer” in cats?

Cats are notoriously good at hiding signs of illness anyway, and because high blood pressure by itself has no symptoms, it is that much more insidious. The condition is most frequently found in older cats, and often secondary to an already existing disease like kidney disease, heart disease, diabetes or hyperthyroidism.

Like in people, high blood pressure causes wear and tear on many parts of the body.  Like a hose with abnormally high water pressure, it can cause damage, leaks and rupture in blood vessels.  What are the effects of ongoing hypertension?

  • Chronic high blood pressure can narrow and thicken the blood vessels of the kidneys, affecting their ability to filter. As the kidneys filter less fluid, waste builds up in the blood. The kidneys may fail altogether.
  • Blindness can come from swelling or bleeding into the eye or detachment of the retina.
  • Arteries may harden, causing the heart and kidneys to have to work harder.
  • High pressure in the brain can cause a break in a blood vessel. This can cause seizures, a stroke or coma. A blood clot blocks can also cause a stroke.
  • The heart has to pump harder & over time this can cause the heart muscle to become enlarged and increase the risks of developing congestive heart failure.

Getting a diagnosis is critical to prevent serious consequences for your feline. To identify the condition, your cat’s doctor will need to measure your cat’s blood pressure accurately – not always an easy thing to do!  Stress from the visit can elevate the blood pressure at least temporarily, resulting in an artificially high reading.

Blood pressure in cats is measured just as it is in humans, with an inflatable cuff and a Doppler, an ultrasonic listening device.  To get an accurate reading, it helps if it is done in a quiet room, where your cat can relax a bit.  The doctor will take several readings to be sure it’s not artificially elevated by stress.  If blood pressure is consistently high and stress is ruled out as a cause, additional tests may be needed, including a complete blood count, blood chemistry, and urinalysis.

Treatment begins with controlling the underlying disease, taking into account any medications that can worsen hypertension, such as steroids, and an evaluation of diet.  If additional treatment is indicated, it will depend on other diseases present. The goal is to reduce the blood pressure into a range that minimizes organ damage.  Once controlled, blood pressure should be rechecked every three months.

I know it’s hard – on both you and your cat – to visit the veterinarian.  But diseases like hypertension can only be diagnosed by a doctor, and your geriatric cat’s life may depend on it.  The American Association of Feline Practitioners recommends blood pressure monitoring as part of a regular bi-annual senior cat exam for all cats.

In the final days of a cat’s life, people often try to get a few more days with their pets.  But early detection and control of hypertension and other geriatric diseases can extend a cat’s life for years!

Staying Within The Budget(s)

February 29, 2012 § Leave a comment

There are so many treatment options in veterinary medicine these days – we can choose cancer radiation treatments, joint replacements, kidney transplants for our pets  – all quite successfully in the right cases.

But we as pet owners almost always outlive our pets, so we are repeatedly faced with making difficult decisions about their care and the lengths we will go to treat them.

So what do you do if you are facing a terminal disease for your pet, you have chosen not try to “cure” the disease and now you are seeing declining quality of life.  The decision on whether and when to choose euthanasia is a difficult and personal one.  You may be thinking you need to postpone it. Maybe you feel your pet still has more good days than bad.  Maybe you want to make it until the next college break, or the end of a deployment.  Maybe it’s not a decision you are emotionally prepared to make.  Veterinary hospice may be something you are considering.

I’ve written about veterinary hospice in the past, and while more and more veterinarians are offering hospice care programs, the truth is many pet owners have been providing basic hospice care for some time – home cooking, help getting outside, cleaning up after daily accidents.  Doctors can prescribe pain control, appetite stimulants, fluids, etc., but whether your veterinarian gets involved or not, when you are providing end of life care for your pet, you need to think about three different budgets:

  1. Your Financial Budget – you have choices about where to spend, but (almost) everyone has a point where they get uncomfortable.  Whether it’s because it’s impacting the overall finances, or others in the family have hit their limit, it’s a finite resource.
  2. Your Time Budget – providing end of life care is a significant commitment for the household as your pet needs more and more help getting around, going outside, staying clean.  Even with veterinary and nursing support, it’s a commitment.
  3. Your Emotional Budget – You’ve had years of love, fun, companionship and experiences.  Hospice care can be an amazing time to prepare to say goodbye, but it will not be easy for you.   The emotional toll of caring for your declining companion requires the biggest budget of the three.

Without enough money, time or emotional currency, you get into a deficit situation that can have a long term impact on your life – it can put at risk finances, relationships, employment.

When any one of the three runs out, it’s important to acknowledge it’s time to do something differently.  As difficult as it will be to ask, find some help from a veterinarian, extra helping hands at home and/or a mental health professional.

You’ve got to balance the budget.

“I don’t want her to suffer”

February 16, 2012 § Leave a comment

No one wants their pet to suffer, but understanding the signs of suffering – often caused by pain – requires careful observation.  Animals instinctively hide signs of pain because, if you think about it, their wild ancestors were at a severe disadvantage if they showed weakness to their pack or their predators.

Learning to recognize pain in our pets becomes even more important as they grow older.  Technically speaking, age is not a disease and age doesn’t cause an animal to be less active or create changes their behavior, however age-related changes in their bodies can.  Arthritis is very common in older animals and although it might start with Monday morning stiffness after a weekend of exercise, over the years it can become chronic (read: constant) pain in the hips, knees, back and neck. (sound familiar?)  Very often the changes our pets go through are so gradual that we have trouble recognizing them.

Some signs are pretty straightforward, like crying, whimpering, growling in reaction to pain.  Limping is always a clear sign of pain, even if your pet has been doing it for a while.  But did you know that when a dog paces, it often means either it hurts to lie down or doing so may make it harder to breath.  Another common situation is an older dog begins snapping at you or other family members.  This often means she is afraid your touch will create more pain.

There are other, less obvious signs that should signal to us that your pet is saying, “I don’t feel good!”

  • Decreased activity level, water consumption or appetite
  • Changes in behavior – isolating themselves or withdrawing from family time and spaces, or hiding
  • Accidents in the house because it hurts to get up to go outside or into the litter box
  • Shivering doesn’t necessarily mean “I’m cold”  it more often means “I hurt”
  • Excessive grooming/licking of a certain area.  Dogs with arthritis do this commonly, or pets with stomach pain
  • Lying, sitting or standing in an unusual body position to favor an area that hurts
  • Pensive posture; not erect, stiff-backed.  Cats get a look in their eyes that we get with a bad headache
  • Their behavior isn’t what you’d expect when you go to touch them

If in doubt about whether your older pet is in pain or not, it’s likely that she is.  Consult your veterinarian for the best way to relieve the pain your pet is experiencing.  Medications, hydrotherapy, acupuncture and massage are all methods that may help.

You’ve said you don’t want your pet to suffer; there is no reason your pet should have to and no excuse for allowing the pain to continue.

Having a Hospice Mindset for Your Aging Pet

January 1, 2012 § 1 Comment

When pet owners ask me whether “it’s time”, I often say to them, “your friend is ready, but he (or she) will wait until you are.  Let’s make sure we keep him comfortable until then.”  This is veterinary hospice.

Veterinary Hospice might be a new term for you to think about, but it’s an idea that makes sense for our animal companions who’s lives are never long enough!  It is end of life care for our animals, focused on the patient and family’s needs.  It is purposefully helping our patient live life as fully as possible until the time of death with or without intervention (euthanasia); and it is allowing you and your family to prepare, to a degree, for the death of your pet.

Hospice starts with “comfort care” – including, as needed supporting your pet’s nutritional and hydration needs, ensuring adequate hygiene and pain control.  It also includes meeting your his or her “happiness” needs with new activities and emotional enrichment as activity becomes more difficult.

In addition to comfort care, the hospice process includes tools that help you to regularly assess your pet’s quality of life and recognize when there are more bad days than good.  It means thinking about ways you want to remember your companion and new memories you may want to create before it’s time.  All of this allows many people to have a more peaceful goodbye when the time comes.  And it can all happen in your home, when you and your family are ready.

Pet hospice is as much about you as it is about your pet.  This is often the most difficult part of pet ownership.  As a caretaker, you may be feeling heavy responsibility making pet healthcare decisions — past present and future — and perhaps anticipating the grief you will feel when your pet is gone.   Keep in mind, this is a uniquely human struggle – our animals are less complicated with their feelings and more in touch with the natural cycle of life.  It’s why we love them as much as we do.

The love between a pet and his or her people is complicated, and many things affect when “it’s time”.  But being able to take advantage of the time you have and then say goodbye in a way that honors the relationship, the commitment and the amazing bond we have often makes the loss easier.

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