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Vet Involvement Key to Success of Pet-Hospice Movement Ranny Green 2011 It’s a scenario we all dread and a sobering reminder that our pet’s stay with us is never long enough: Fido suddenly becomes very ill, or quits eating, or is in pain with each step he takes, or begins coughing and vomiting blood. You quickly call your veterinarian and rush him in for diagnosis and treatment. After a battery of tests and X-rays, the veterinarian either sends you home with a handful of medications until he/she receives the laboratory results the following day or refers you to a nearby emergency hospital in hopes of stabilizing the patient’s condition. And then the waiting begins. It seems like the longest 12 hours in your life until the phone rings the next day. Your optimism or glass-half-full outlook is suddenly crushed when the veterinarian says gently your dog is suffering from a terminal disease leaving it with only several weeks or possibly a few months to live. Tears begin streaming down your face, and moments later your once-smooth psychological landscape is converted into a rocky mix of shock and pain. It takes time – a few minutes, hours or even days, in some cases — to collect your thoughts, digest everything and then ask for your veterinarian’s suggestions on a course of action. Quality of life is the No. 1 priority for this valued family member, but how to maintain that is equally important.
Pet hospice has become a valuable option – 40 years after the modern human hospice became an alternative for terminally-ill patients dying in hospital intensive-care facilities. The No. 1 caveat, however: Only a small percentage of veterinarians embrace the concept. If the American Veterinary Medical Association national convention in Atlanta this summer is any indication, the door is slowly being nudged open. Several veterinarians, including Dr. Tina Ellenbogen, of Bothell, addressed large crowds there on cutting-edge hospice care and pain management and the need to incorporate these in their practices. For two decades Ellenbogen has championed hospice care in her profession and practice, and she left Atlanta feeling good about its future. ―Veterinary/animal hospice is here to stay. It’s a specialty on the rise, although it is not board-certified as yet. But with pain management becoming a specialty, hospice should follow,‖ she says. ―Conventional /traditional vets may not be embracing it yet, but they are seeing that clients know of it and want that option. Practitioners don’t have to incorporate it into their practice, but need to know those specialty practices and they can refer to those. They also need to recognize that they can incorporate the parts of hospice that interest them and refer the other parts.‖ Ellenbogen, who operates a mobile practice, is often called upon to offer euthanasia services for beloved family pets in owners’ homes, but chiefly focuses on assessing the patient’s health status in the home with the family so that all parties can discuss end-of-life options and comfort care. ―Clients’ feelings vary widely,‖ she says. ―The focus needs to be on orchestrating a peaceful, graceful goodbye without fear or regret. Some clients are well-prepared and some have a hard time letting go. This is no time for conflict or differences. I am in the home to provide comfort, relieve suffering and honor the pet.‖ Dr. Carrie LaJeunesse, a Southworth (Kitsap County) veterinarian and president of the Washington State Veterinary Medical Association, says the organization ―has always been progressive and open-minded. We recognize hospice as part and parcel of what veterinarians do. We obviously acknowledge that dying is a natural process and that we’re here to help the patients and their owners navigate that physically and emotionally. ―Because we are not trained to deal with psychological stress, we have our limits. Just like any other profession, some handle owner grief better than others. It’s incumbent on all of us to sit down with each grieving owner and ask what she or he needs beyond the medical care we offer. Then we must immediately find them the resources to deal with that.‖ In Atlanta, Dr. Tami Shearer, of Dillsboro, N.C., led two sessions, ―Quality of Life: Setting Up Hospice and Palliative Care Services in Small Animal Practice‖ and ―Quality of Life: Hospice and Palliative Care Protocols,‖ emphasizing that as pets are recognized as family members, owners seek medical care that more closely matches that offered to humans. Prompted by that demand, Shearer has developed a five-step protocol to guide veterinarians through a treatment mode: (1) Evaluation of the owners’ needs beliefs and goals for the pet. (2) Education about the disease process. (3) Development of a personalized plan for the pet and owner. (4) Application of hospice or palliative-care techniques. (5) Emotional support during the care process and after the death of the pet. After offering house-call services for years, Shearer founded the Pet Hospice and Education Center in Columbus, Ohio, in 2003. ―My long-term vision was, and still is, that no one should have to euthanize their pet because they can’t afford palliative care,‖ she emphasizes. One of the keys to the acceptance of pet-hospice in the mainstream veterinary community will be its emphasis in the curriculum of the nation’s 28 veterinary colleges. At this point only Colorado State University focuses on it to a limited degree. Gail Bishop, co-founder and co-faculty advisor of the CSU program, explains, ―Our curriculum does not include pet-hospice per se. We teach end-of-life issues and quality of life in many of our core classes, especially in the students’ junior and senior years. Those students who choose to volunteer with us receive pet-hospice education. But that is a small percentage.‖ Those volunteers visit homes of terminally ill patients in nearby Fort Collins and Loveland, Colo., on a schedule dictated by the referring practitioner. During the visit they provide pain control and physical comfort in addition to assisting with prescribed hydration and nutrition therapies. Following each visit, the volunteer case manager updates the referring veterinarian of the patient’s physiological status. Washington State University College of Veterinary Medicine offers ―comfort end-of-life‖ advice in some of its classes, particularly those relating to oncology