Skip to main content

Blog Archives

Making the Most of End-of-Life QOL

Creating a high-quality end-of-life period is a critical aspect of veterinary practice. Although we can’t prevent the inevitable passing of a beloved pet, we can advocate for patient comfort and support pet parents through end-of-life care decisions. Fear Free Certified® Professionals are uniquely qualified to help pets with terminal and progressive diseases overcome not only physical barriers to increased life quality but also emotional and behavioral impacts. Here, we discuss best practices to improve quality of life (QOL) during a pet’s last days.

Assessment and Planning

Effective end-of-life care begins with a thorough patient assessment and history to evaluate the pet’s current QOL, establish management goals, and develop a treatment plan in partnership with the pet owner. Many physical, emotional, and social factors contribute to patient comfort and wellbeing, with each weighted differently for individual pets. A professional QOL scale provides clients and the veterinary team with an objective measurement tool to track disease progression and QOL changes, facilitating discussions about palliative care or euthanasia.

Palliative and Hospice Care

Palliative and hospice care focus on reducing the impact of disease symptoms, improving comfort when a cure is unlikely, and supporting pet families during a pet’s final days. Many hospice caregivers provide in-home services, which can help reduce stress levels and give the family more time with the pet. Hospice care often culminates in euthanasia or a medically assisted natural death.

Supporting Quality of Life

End-of-life care should focus primarily on implementing strategies to manage pet comfort. Pet professionals should consider the following QOL assessment categories to develop effective interventions:

  • Happiness — Increase pet happiness by modifying activities they once enjoyed and continuing to provide enjoyable social interactions and play.
  • Mental state — Pets experiencing pain, cognitive decline, or other effects of chronic illness may also suffer from fear, anxiety, and stress that impacts life quality. Address behavioral changes with medications, supplements, training, calming aids, and household management.
  • Pain — Uncontrolled pain is the hallmark of reduced QOL. Address pain early and aggressively, emphasizing the importance of pain control to clients. Medications, rehabilitation, and alternative treatments are viable options.
  • Appetite — Consider appetite stimulants, antiemetics, and high-energy diets for pets dealing with anorexia or weight loss.
  • Hygiene — Pets unable to stay clean are uncomfortable and at risk for skin infections. Work with clients to find solutions that are not overly burdensome, such as bathing, diapers or belly bands, or medications to control urinary and GI conditions.
  • Hydration — At-home subcutaneous fluids are an excellent solution for keeping chronically ill pets hydrated when they are unable or unwilling to drink enough water.
  • Mobility — Poor mobility can limit a dog’s ability to interact with the world around them. Address mobility by selecting safe pain and anti-inflammatory medications and by modifying the home environment with rugs or runners to provide traction. Support harnesses and carts may also be appropriate.

Client Support

Open and empathetic communication with pet owners is essential during the end-of-life period. Veterinary professionals should provide education about the pet’s condition, prognosis, and care options and remain open-minded and non-judgemental during discussions. End-of-life care can take a physical, emotional, and financial toll on clients. Offering simple treatment regimens with the most bang for their buck can reduce the caregiving burden and prevent breakdowns in the human-animal bond.

With a compassionate approach, veterinary professionals can provide exceptional care and QOL during a pet’s final days. The Dechra Quality of Life Survey helps veterinary professionals and pet owners take a step back to objectively assess the pet’s current state and track changes over time. We encourage pet professionals to share the survey with clients and use their answers to discuss treatments and guide decision-making.

For pets facing a lymphoma diagnosis or relapse whose owners cannot or do not wish to pursue chemotherapy, consider Laverdia, an oral drug designed to target cancer cells and spare healthy ones to prolong time to progression (TTP) in canine lymphoma. Learn more about Laverdia here.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Brought to you by our friends at Dechra.

Aging Gracefully: Update on Canine and Feline Cognitive Dysfunction Syndrome

Course Overview

In part due to the excellent veterinary care that we deliver to our patients, we are presented with more geriatric cats and dogs now than we were 10 years ago. Most of us didn’t learn much about how to recognize and treat cognitive dysfunction syndrome (CDS) in dogs and cats. In this presentation, Lisa Radosta, DVM, DACVB, discusses the most up-to-date prevention strategies and treatments of CDS in dogs and cats.

This course is approved for one hour of RACE CE and one hour of IAABC CE. In order to obtain the CE and certificate, you must enroll in and complete the course quiz with a score of 80% or better.

Brought to you by our friends at Zoetis Petcare

||

Certified Practice Exclusive: Fear Free Euthanasia Best Practices

Euthanasia is one of the most emotional and memory-invoking procedures we do as veterinary professionals. Veterinary staff and clients desperately want these final moments to be as smooth, stress-free, and pleasant as they can be.

Our own Practice Certification Manager Jennifer Merlo, DVM, joins CAETA (Companion Animal Euthanasia Training Academy) founder Kathleen Cooney, DVM, MS, CHPV, CCFP to discuss how you can make this sacred time as Fear Free as possible. Dr. Cooney also shares her best recommendations on how to set up a Fear Free euthanasia room in your practice.

Kathleen Cooney, DVM, CHPV, CCFP has been practicing advanced end-of-life care since 2006. She is CEO and Director of Education for the Companion Animal Euthanasia Training Academy (CAETA) and Chief Medical Officer of Caring Pathways, Inc. Dr. Cooney is a past President of the International Association for Animal Hospice and Palliative Care (IAAHPC) and assisted in the development of AAHA’s End-of-Life Accreditation Program. She is well-known for her work in companion animal euthanasia and has authored two books on the subject along with numerous articles and book chapters. Dr. Cooney has collaborated in end-of-life training for the AVMA, AAHA, NAVC, IAAHPC, Fear Free Program, SVME, and many more. She is a strong advocate for best practices in all aspects of end-of-life care and speaks nationally and internationally on such topics. Dr. Cooney is also currently working towards board certification in animal welfare, expected by 2024 and is Affiliate Faculty at Colorado State University where she teaches end-of-life topics and welfare. She loves all things old and gray.

You must be a Fear Free Certified Practice member and logged in to view this webinar.

|

Aging Gracefully: Update on Canine and Feline Cognitive Dysfunction Syndrome

In part due to the excellent veterinary care that we deliver to our patients, we are presented with more geriatric cats and dogs now than we were 10 years ago. Most of us didn’t learn much about how to recognize and treat cognitive dysfunction syndrome (CDS) in dogs and cats. In this session, attendees will learn the most up to date prevention strategies and treatments of CDS in dogs and cats.

In this webinar, Lisa Radosta, DVM, DACVB, will cover:

1. The most common clinical signs of CDS
2. The most commonly used treatments
3. How non-medical treatments can be effective in the management of CDS patients

About the Presenter

Lisa Radosta, DVM, DACVB, graduated from the University of Florida College of Veterinary Medicine in 2000. After completing an internship in small animal medicine and surgery at Coral Springs Animal Hospital, she worked as a primary care veterinarian for two and a half years. She completed a three-year residency in behavioral medicine at the University of Pennsylvania in 2006 and passed the board examination later that year. During her residency, she received the Resident Research Award from the American College of Veterinary Behaviorists (ACVB) two years in a row.

Dr. Radosta lectures nationally and internationally for veterinary professionals and pet owners and is the author of a number of textbook chapters and scientific research articles, She also co-authored “From Fearful to Fear Free: A Positive Program to Free Your Dog from Anxiety, Fears, and Phobias” with Dr. Marty Becker, Mikkel Becker, and Wailani Sung.

She is the section editor for Advances in Small Animal Medicine and Surgery and served on the 2015 AAHA Canine and Feline Behavior Management Guidelines Task Force.

This webinar is brought to you by our friends at Zoetis Petcare.

Fear Free Euthanasia: Help Pets and People Say Goodbye Peacefully

Julie Liu, DVMPet parents will remember their animal’s euthanasia for the rest of their lives, and if their pet is agitated or anxious, they’ll remember that, too. Helping them to plan ahead can make the experience easier for your patients and their families.

When people make the difficult decision to euthanize a pet, there are many other smaller decisions they’ll have to make, such as when to schedule and whether they or their children should be present. Among the details that should be considered on your end is how you can reduce the animal’s fear, anxiety, and stress during their final moments.

When pets have a fear of the veterinarian and are brought in for euthanasia, their stress levels can escalate. The procedures that may take place before euthanasia can be scary or painful, such as being restrained by a veterinary staff member while their front leg is shaved and an IV catheter is placed. While this usually occurs away from the owner, the experience is often stressful enough that the difference is noticeable when the pet is returned to the exam room.

Even if a particular patient doesn’t routinely require anti-anxiety medications, consider them when clients are bringing pets in for euthanasia. Many pet parents have concerns about their sedating effects, but this is one instance where it truly doesn’t matter–sedation will only help the euthanasia go more smoothly. Dispense them at least a few days ahead of time to ensure that the client is able to give a test dose before the day of the pet’s euthanasia. Some anti-anxiety medications such as gabapentin also help reduce pain, so they can decrease discomfort to procedures such as IV catheter placement prior to euthanasia. If your patient is agitated or is still fearful despite oral pre-visit pharmaceuticals, consider injectable sedation prior to euthanasia. The last thing a pet parent wants to see in their time of grief is their pet flailing, vocalizing, or trying to escape. Sedation will decrease stress for the pet and their family.

If your practice routinely uses IV catheters for euthanasias, have clients rub a lidocaine numbing cream such as Supernumb on the tops of their pet’s forelegs several hours prior to euthanasia. IV catheter placement is painful, and numbing the area will make for a more compassionate experience, especially since multiple catheter attempts are sometimes needed in debilitated pets .

In your Fear Free practice, you use treats with patients during routine visits, and you can use them with euthanasia, too. Providing a smorgasbord of vanilla ice cream, lunch meat, cheese chunks, Churu, peanut butter, or whipped cream will allow clients to continue bonding with their pets while lowering their stress. Take care to avoid giving greasy foods such as burgers–while tempting to offer as a last meal, they can cause nausea and gastrointestinal upset.

If you don’t offer housecalls for patient euthanasia, I urge you to consider it. Even pets who don’t have a strong fear of veterinary visits will never be as relaxed at the vet as they will in their home, with their familiar bed and environment. You can even have classical music playing quietly in the background to help create a calming environment. I’ve euthanized several pets in their homes, and in every instance I felt that the experiences of the pet and the owner were better than they would have been in the clinic environment.

Pets deserve to have a Fear Free death as much as they deserve to have a Fear Free life. By considering a patient’s emotional health during their final days, you’ll help make their passing as compassionate as possible.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Julie Liu, DVM, CVA (Certified Veterinary Acupuncturist) is a small-animal veterinarian who practices in Austin, Texas. In addition to advocating for Fear Free handling of pets, she is passionate about feline medicine and senior pet care.
 

Esophagostomy Tubes: Fear Free Tools for Disease Management

Julie Liu, DVMSeveral months ago, my senior Bichon mix, Dorie, developed severe gastrointestinal issues. She was trembling with pain and nausea, stopped her favorite pastime of body slamming her toys against the couch, and eventually became inappetent.

Medicating Dorie has always been a challenge because she can sniff out anything no matter how well I try to hide it, but during her illness it became impossible. Even worse, the fear, anxiety, and stress (FAS) she experienced during my attempts to medicate her were almost as traumatizing to me as a pet parent as they were to her. When she didn’t respond to hospitalization I brought her to a specialty hospital for endoscopic biopsies, and during her anesthetic procedure the internist placed an esophagostomy tube (E tube).

The sense of relief I felt at having the option to medicate her and feed her through the tube without causing FAS was immense. Dorie was ultimately diagnosed with inflammatory bowel disease and required weeks of immunosuppressive doses of steroids before she started body slamming her toys again, and without her E tube I wonder if she would have recovered.

As Fear Free practitioners we always try to consider a pet’s wants vs. needs, but when treatments are medically indicated for an unwilling sick pet, we have to find a different approach. The use of E tubes provides a compassionate solution to disease management that should be considered for a variety of illnesses and not only as a last resort.

Indications for E Tube Placement

Historically, many veterinarians have recommended E tubes for gastrointestinal diseases such as feline hepatic lipidosis, cholangiohepatitis, IBD, and pancreatitis. These pets can have a prolonged road to recovery and the conversation about E tube placement should be started with clients early–when their pet has had anorexia reported for a few days. At best, syringe feeding an icteric cat with hepatic lipidosis can fall short of the caloric needs required for their recovery. At worst, it can result in aspiration pneumonia, fear of the client, and injuries as the client struggles with the pet.

Conditions that cause oral pain, such as facial trauma and significant dental disease, are additional indications for E tubes when we consider the role of pain in contributing to FAS.

Rather than sending a pet home after full-mouth extractions with some canned food and oral pain medications and hoping for the best, we can have a proactive discussion with the client about an E tube at the time of surgery. This is particularly important in cases where the pet has already had decreased appetite preoperatively and adds minimal time and cost to the procedure. In cases of oral neoplasia where the client is not ready to pursue humane euthanasia, placement of an E tube to deliver nutrition and analgesia may provide at least some relief to the patient until the next quality of life discussion with the client.

In pets with chronic kidney disease, an E tube can make a huge impact on long-term management and maintaining the client-pet bond. I remember attempting to give subcutaneous fluids to my first cat with kidney disease and managing exactly one poke before she jumped off her cat perch and ran away while the fluid line whipped around, spraying fluids everywhere. Some clients are also uncomfortable with handling needles and having to inject their pet with fluids and can inadvertently poke themselves in the process. An E tube can allow a client to administer daily fluids and anti-nausea medications easily without causing FAS or discomfort.

In addition, many pets with CKD find renal diets unpalatable and develop nausea, inappetence, and weight loss as their azotemia worsens, leading their owners to feed them whatever they will eat. Placement of an E tube ensures that their pet will receive both adequate nutrition needed to maintain their body weight as well as the recommended prescription diet to try to slow progression of their disease.

While there may be an increased level of anesthetic risk for patients with CKD or other underlying health conditions, placement of an E tube1 is very quick (typically less than 30 minutes for placement and radiographic confirmation of location) and can provide weeks to months to even years of benefit. Once the stoma heals, it may be possible to exchange the tube through the same stoma site without general anesthesia by using topical anesthesia and the techniques outlined by Dr. Sheri Ross in 2016, in which she describes one feline patient with CKD whose stoma site was maintained for almost 5 years using E tube exchanges2 .

Client Education

Perhaps one of the challenging aspects of E tubes is overcoming the perceived stigma attached to the tube itself. Some clients may agree to several days of hospitalization for their pet but draw the line at an E tube because they associate it with end-of-life care. While this may be true with some conditions such as oral neoplasia, in others an E tube can actually save their pet’s life or improve management of a chronic disease. Most pets with an E tube also don’t seem to notice it at all, and will eat, drink, groom, and even body slam their toys with their E tube in place.

Some clients may also feel squeamish at the prospect of handling and using an E tube for their pets. Washable, patterned neck wraps such as the Kitty Kollar3 or Kanine Kollar have been amazing at minimizing the “medical” aspect of E tubes, and their website provides a great starting point for educating owners when initiating an E tube conversation. Once the E tube is placed and the pet is ready to be released from the hospital, provide written discharge instructions4 with a recommended schedule for medicating, watering, feeding, and cleaning based on that pet’s calculated water and caloric requirements to ensure that the pet is getting everything they need. Scheduling a teleconsult the following day and printing a weight chart for the patient at every recheck will provide additional guidance and positive reinforcement. When your client realizes how easy it is to treat their pet with the E tube, you can consider asking them to be a resource for others who are on the fence about having one placed for their pet.

Summary

E tubes can be used successfully for a variety of acute and chronic illnesses, and their ability to remove the FAS associated with treatments is significant. Weighing the risks vs. benefits of the brief anesthesia needed for placement is important, but when routine medical management is inadequate, we need to be proactive in advocating for our patients and work together to destigmatize these invaluable tools.

Resources

  1. https://www.cliniciansbrief.com/article/esophagostomy-feeding-tube
  2. Ross, S. Vet Clin North Am Small Anim Pract. 2016 Nov;46(6):1099-114.doi: 10.1016/j.cvsm.2016.06.014. Epub 2016 Aug 5. Utilization of Feeding Tubes in the Management of Feline Chronic Kidney Disease
  3. https://www.kittykollar.com
  4. http://vhc.missouri.edu/small-animal-hospital/small-animal-internal-medicine/diseases-and-treatments/esophagostomy-tube-information-and-care

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Julie Liu, DVM, CVA (Certified Veterinary Acupuncturist) is a small-animal veterinarian who practices in Austin, Texas. In addition to advocating for Fear Free handling of pets, she is passionate about feline medicine and senior pet care.
 

Fear Free Companion Animal Euthanasia Course

Every pet’s final visit to the veterinarian should be as Fear Free as the first. In this one-hour module, you will learn how to utilize pre-planning to create a meaningful and low-stress experience for pet and owner. It will cover uses of pre-euthanasia sedation and anesthesia to give the pet a gentle euthanasia and the benefits and downsides of different euthanasia techniques. Also explored will be the dangers of compassion fatigue and how to prevent or alleviate it.

This course was written by Kathleen Cooney, DVM, MS, CHPV, founder of the Companion Animal Euthanasia Training Academy.