More Than Pain Management
Everyone says that they do not want their pet to suffer. When asked to clarify, we usually fear physical suffering of some kind: pain, nausea, breathlessness, etc. In a being who cannot verbalize his subjective experience, fear of unrecognized physical suffering is understandable. Thankfully, there is much we can do to alleviate the physical symptoms of disease and dying. And while we can never know for sure what another feels or senses, physical pain, nausea, and breathlessness are, well, physically apparent.
But we sometimes forget that the social, emotional, and mental distress our pets often endure with disease, illness and death can be just as, if not more, important. In beings who can verbalize their fears, needs, wants, and subjective experience (humans), these aspects of care can have a stronger impact on quality of life than physical ones.
While the inner lives of animals is debated, for those of us who love them, it is obvious they have emotions, love, relationships, and thoughts.
When an animal is undergoing treatment, it doesn’t understand why it must endure the stress and fear of the diagnostics and medications. Consider learning more about managing your pet’s fear, anxiety, and stress through Fear Free , seeking out a veterinarian or hospital certified in Fear Free or certified in Low Stress Handling. Try to choose modalities and treatments that are most compatible with an animal’s personality. If your cat hates strangers, acupuncture is probably not the best choice. Sedation, behavior modification, anti-anxiety medications, and taking more time to gain trust can go a long way. In home care or telemedicine may be best for some patients.
Some of the lifestyle changes that occur with disease can lead to boredom and anxiety, confusion, and fear. Blindness, cognitive disease, and loss of hearing can lead to increased confusion. Modifying their environment to prevent falls, or becoming trapped, by using scents, baby gates, and avoiding rearranging furniture can be helpful. Animals who are experiencing mobility difficulties can be anxious about falling or slipping, or stressed that they cannot get outside to eliminate. Environmental modifications, assistive and support devices, and just being more aware of body language can make a huge difference for these handicapped pets. Food puzzles, soft chew toys, different scents, open windows, music, pheromones, car rides (dogs) and use of strollers, carts, etc can help manage boredom.
People who have a chronic illness or chronic pain or who are in hospice report a better quality of life and live longer if they have a good social support system. It’s important to address concerns about loneliness, isolation, and changes in socialization that may occur with illness and try to accommodate as much as possible. If a pet's disease causes them to need to be separated from their family, this should be corrected as much and as soon as possible. There is a reason separation anxiety is one of the most common behavior problems reported in dogs and cats.
Changes in the environment to allow for better ease of care and hygiene, or having other professionals help with care in the home (nurses, pet sitters, dog walkers) can help return an animal to the family environment. In addition, illness can lead to changes in relationships between pets. Fragile or weak animals should have a safe, protected place, but still be allowed to interact with other pets if they enjoy it.
Being comforted by a loved one can reduce pain, fear, anxiety, and stress, as much as any medication. Every effort should be made to keep our pets in the home, and allow families to visit hospitalized pets. Fear free practice avoids separating animals from the owner, and “taking them in the back.” This is especially true with end of life care.
As doctors, we want to heal, to fix, to cure. When this is no longer possible, or in the best interest of the patient, let us remember that our patients and their families deserve to live, and to cherish, the moments they have at the end. As Atul Gawande said in his book Being Mortal: Medicine and What Matter in the End, “Our ultimate goal, after all, is not a good death, but a good life to the very end.” As a profession, we have mastered the “good death,” and I believe that if we can apply the principles and skills of animal welfare, behavior medicine, and human hospice and palliative care to the end of life, we can master the good life to the very end for our pets too.
www.pethospice.com: chronic pain scales, free webinars on quality of life and recognizing pain, and quality of life consults via telemedicine with Shea Cox DVM, CHPV, CVPP
www.iaahpc.org: International Association of Animal Hospice and Palliative Care. Interdisciplinary organization devoted to advancement of end of life care in animals and their families. Continuing education, yearly conference, and certification in animal hospice and palliative Care available for veterinarians, technicians, and social workers.
www.ivapm.org: International Veterinary Association of Pain Management. Continuing education, research, and client education on pain management in animals.
www.caninearthritis.co.uk: Information for owners and veterinarians on multimodal management of arthritis that goes beyond pharmaceuticals
http://foodpuzzlesforcats.com: Descriptions and ideas for interactive toys for cats
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