When should you offer palliative care?
The time to discuss and offer this is when an animal approaches the end of its life. Some of the common circumstances include;
- When a diagnosis of a life-limiting illness has been made
- When you decide to no longer try to offer curative treatments
- When symptoms of the disease get worse and interfere with the quality of life
Quality of life and planned palliative care – 15 suggestions
There are many factors affecting an animal’s quality of life, all of which need to be considered. You need to understand the needs of the animal and family, so you can help by discussing potential problems as well as offering some solutions to ensure the family can prepare.
- Talk to the family – try to understand what the they all want and expect from the last few days and weeks with their pet. There may be some differing views expressed by different family members.
- The average day – find out what the family and pet do on an average day. This will help you to tailor the needs of the pet according to what the family can commit to.
- Teach and inform - knowledge is power, and the owners understanding about their pet’s prognosis will help you personalise a plan.
- Treat the symptoms – aim to recognise clinical problems and take action to improve the animal’s health wherever possible. For example, pain relief may be the priority.
- Pain – we should as far as possible ensure that an animal is not suffering unnecessarily. A pain free life should be our target. There’s lots we can do;
- Analgesics – NSAID’s, Opiates e.g. Tramadol, carprofen etc.
- Nutraceuticals – glucosamine, chondroitin, green lipped mussel extract may help.
- Acupuncture – this is often under used, but well worth considering.
- Physiotherapy and massage – this can be taught to owners to try at home. Most animals find massage to be comforting.
- Laser therapy – this can help the nervous system, increase circulation and decrease inflammation.
- Respiration – always help an animal with breathing difficulties. Owners should be given guidance on recognising if and when their pet has respiratory problems. E.g. abdominal breathing, flared nostrils (rabbit) or open mouth breathing (cats).
- Comfort – be aware of when a patient is in distress. They may be unsettled, restless and preoccupied, constantly changing position rather than looking content.
- Control nausea – many animals will feel nauseous, especially those that are being treated with chemotherapy, or perhaps have chronic end stage renal failure. Examples of some drugs which have been used to help include maropitant citrate, metoclopramide and mirtazapine.
- Satiation – we should safeguard an animal against hunger, thirst and malnutrition. Hand feeding works well with most species and will have an important role in ensuring sufficient calories and fluid are consumed. Have you read our article on assisted feeding in rabbits?
- Cleanliness – pay particular attention to an animal’s ability to keep itself from faecal soiling and urine scalding. Eyes and ears may also need to be cleaned more regularly. Place litter trays in a more suitable/accessible location.
- Mobility – this is most important for the animal’s welfare. They may need help to get up, move around and go for walks. Older dogs may need lifting and support to get out into the garden. Some owners may find a ‘sling support’ under the animal a useful aid to help them keep their pet active.
- Safety – weak, elderly and sick animal living at home will almost certainly be more at risk from all sorts of obstacles and events. Go through all the potential problems and give suggestions as to how to keep them safe. Some examples include;
- Stair gates – elderly dogs need to be prevented from going up and down stairs on their own, as there is a real risk of falling.
- Flashing collars – an old, partially sighted and deaf dog on a walk at night can easily go missing in seconds. A bright flashing collar will help the owner keep sight of their pet.
- Winter coat – elderly and sick patients will find it harder to keep warm on a cold night. Encourage the use of a comfortable and warm jacket.
- Non-slip floors – older dogs will benefit in the home by having extra rugs or carpets put onto slippery floors.
- Contentment – this is often achieved by allowing an animal to express interest in daily activities and habits. Most domestic pets like and need social interaction. If they are unable to move about the home, there is a risk they may become isolated and forgotten. Encourage owners to make sure they are kept involved with the family’s routine.
- Take one day at a time - in the final life stages of a terminal condition (e.g. end-stage kidney or heart failure), the goal of palliative treatment will be making every day as good as it can be.
- Discuss euthanasia – it’s important to discuss this beforehand. Almost all owners will appreciate this, even though they will find it difficult to raise the subject. Most of them are usually comforted by how quickly, quietly, and peacefully an animal passes away during euthanasia.
How do you know when palliative care is no longer working?
One of the best questions to ask yourself and the owner is "are there more good days than bad days?" When bad days outnumber good days, the quality of life is almost certainly no longer sufficiently good enough to justify continuing. At this stage, euthanasia should be discussed.
Should we support a natural death as an alternative to euthanasia?
There are some pet owners who really struggle with the thought of having to make a decision to have their loved companion put to sleep. In these circumstances, especially if you consider that the animal is starting to suffer, should we allow the animal to die a “natural death” under our supervision? After all, this is what happens in human medicine. This may obviously create an ethical dilemma, but we have a duty as veterinary surgeons to look after the welfare of the animal at all times. There is no justification at all to allow the animal to suffer for the benefit of the owner. We could however, in a very planned way, help the animal to go to sleep peacefully at home using pain killers and sedatives, in such a way as to allow the animal to drift into a deeper and deeper sleep.