• Hospice and Palliative Care for Companion Animals

    A thoroughly updated and expanded new edition of the only book providing comprehensive treatment of hospice and palliative care in veterinary medicine

    Animals with life-limiting illnesses deserve compassionate, thoughtful, end-of-life care. Their caregivers and families, faced with the loss of a beloved companion, deserve empathy, support, and education, to guide them through an emotionally wrenching period and provide their companion animals with the highest possible quality of life. In recent years, the ethics of care and service to sick and dying animals and their caregivers has been the subject of considerable attention.

    Hospice and Palliative Care for Companion Animals, 2nd Edition provides a thorough update to the first and only complete guide to this field of service, its foundations, and its applications. It addresses the needs of pets, caregivers, and veterinary professionals alike, including fundamental ethical and emotional principles as well as detailed discussion of specific illnesses and life-limiting conditions. The expanded second edition incorporates cutting-edge research into animal behavior and cognition to enrich the reader’s understanding of companion animals’ emotional needs and their experience of illness and death.

    Hospice and Palliative Care for Companion Animals, 2nd Edition readers will also find:

    • Existing chapters expanded to incorporate new research and practical experience
    • New chapters discussing factors underlying the decision to euthanize, the potential role of ethology in palliative care, and more
    • A companion website with educational handouts for use in veterinary practices

    Hospice and Palliative Care for Companion Animals is an indispensable resource for caregivers and veterinary professionals alike.

  • List of Contributors xxi

    Acknowledgments xxiii

    About the Companion Website xxiv

    Part I Core Concepts 1

    1 Introduction 3
    Pierce, BA, MTS, PhD

    References 5

    Further Reading 5

    2 What Is Animal Hospice and Palliative Care? 6
    Amir Shanan, DVM and Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, MSTCVM

    Introduction 6

    History of Animal Hospice 8

    Scientific and Philosophical Roots 8

    Early Beginnings 9

    Organization and Recognition 10

    Animal Hospice and Human Hospice 12

    Ethical and Legal Differences 12

    Economic Differences 13

    Summary 14

    References 14

    3 The Interdisciplinary Team 16
    Tammy Wynn, MHA, LISW, RVT, CHPT and Amir Shanan, DVM

    Interdisciplinary Teams in Human Hospice and Palliative Care 16

    Interdisciplinary Teams (IDT) in Animal Hospice and Palliative Care 17

    Operating a Successful Interdisciplinary Team 18

    Common Mission and Vision 18

    Team members, Their Roles, and Responsibilities 19

    Effective Communication and Collaboration 22

    Summary 25

    References 25

    4 Quality of Life Assessments 26
    Jessica Pierce, BA, MTS, PhD and Amir Shanan, DVM

    What are Quality of Life Assessments and Why are they Important in End- of- Life Care? 26

    Definitions of Quality of Life 26

    Quality of Life and Well- being 27

    Quality of Life Assessments and Euthanasia Decisions 28

    The Importance of Context in Quality of Life Assessment 28

    Quality of Life and Patient- Centered Care 29

    Physical Discomfort, Emotional Distress, Pain, and Suffering 30

    Coping and Adaptation 32

    Measuring Quality of Life in Animal Patients 33

    A Variety of Approaches to QOL 34

    McMillan’s Affect Balance Model 35

    Weighing Positive and Negative Affect at the End of Life 36

    Quality of Life Assessment Tools 36

    Quality of Life Assessment Over Time 38

    Summary 40

    References 40

    Further Reading 42

    5 Recognizing Distress 44
    Emma K. Grigg, PhD, CAAB, Suzanne Hetts, PhD, CAAB, and Amir Shanan, DVM

    Stress, Distress, Emotions, and Suffering 44

    The Stress Response 44

    What Is Distress? 45

    Behavioral Needs of Dogs and Cats 46

    Assessing Quality of Life in Nonhuman Animals 47

    Relevance to Animal Hospice and Palliative Care (AHPC) 48

    Are Humans Adept at Recognizing Emotional States in Animals? 49

    Body Language of Fear, Anxiety, and Pain 49

    Fear- and Discomfort- Related Body Postures Commonly Observed in Dogs and Cats 49

    Pain- Related Facial Expressions Commonly Observed in Dogs and Cats 51

    Relevance to Animal Hospice and Palliative Care (AHPC) 52

    Changes in Behavioral Patterns as Indicators of Pain and Distress 53

    Do Animals “Hide” their Pain? 53

    Decreased Response to and Engagement with their Surroundings 54

    Unusual Patterns of Movement or Positioning 55

    Focused Attention to One Specific Body Part 56

    Displacement Behaviors 56

    Can Sick Animals Suffer from Boredom? 56

    Relevance to Animal Hospice and Palliative Care (AHPC) 57

    End- of- Life Decisions 57

    Conclusion 58

    References 58

    6 Balancing Efficacy of Treatments Against Burdens of Care 62
    Kristina August, DVM, GDVWHM, CHPV

    Establishing the Goals of Care 63

    Assessing Efficacy and Burdens of Medical Treatment 66

    Assessment of Treatment Efficacy 66

    Appetite and Hydration Needs at the End of Life 66

    Emotional Well- Being 67

    Animal Individual Preferences 67

    Do- Not- Resuscitate and “Advance Directives” 67

    Assessment of Treatment Burden 68

    Assessing Diagnostic Procedures 69

    Adverse Events: Treatment- Related Consequences 70

    Steroids and End- of- Life Care 71

    Adverse Events: Indirect Consequences of Medical Care 71

    Assessing the Burdens of Caregiving 72

    Conclusion 73

    References 73

    7 Ethical Decision- Making in Animal Hospice and Palliative Care 76
    Jessica Pierce, BA, MTS, PhD and Amir Shanan, DVM

    A Method for Moral Decision- Making 77

    Part 1: Clinical Considerations and Their Moral Dimensions 77

    Part 2: Patient Considerations: How the Animal Feels and What the Animal Wants 78

    Understanding What Animals Want 79

    Will to Live 79

    Respecting What Animals Want 80

    Suffering 80

    Part 3: Human Factors Influencing Moral Decision- Making 83

    Providing Adequate Information 85

    Guiding Client Decision- Making: How Much Is Too Much? 86

    Guiding the Choice between Euthanasia and Continued Palliative Care 88

    Societal Ethics and the Role of Cultural Values 90

    Ethical Business Practices 91

    Moral Stress, Decisional Regret, and Mental Health 91

    Conclusion: Finding the Path of Least Regrets 92

    References 93

    8 Supportive Relationships: Veterinarians and Animal Hospice Providers’ Nonmedical Roles 95
    Amir Shanan, DVM and Laurel Lagoni, MS

    Defining the Nonmedical Roles of Veterinary Professionals and Other Animal Hospice Providers (except licensed mental health professionals) 98

    The Role of Source of Support 98

    The Role of Educator 100

    The Role of Facilitator 100

    The Role of Resource and Referral Guide 101

    Resources 101

    Extended Services 102

    Limiting the Role of Animal Hospice Veterinary Professionals and Other Providers (except licensed mental health professionals) 102

    Know Thyself, Healer 105

    Conclusion 105

    Grief Support Resources 106

    Memorials and Grief Support Resources 106

    Counselors and Grief Support 106

    Grief Support Training 106

    Books for Caregivers 106

    Books for Veterinarians 107

    References 107

    9 Management and Administration: Business Models 108
    Kathleen Cooney, DVM, MS, CHPV, CCFP

    Guidelines for Animal Hospice and Palliative Care Practice 108

    Service Delivery Models 109

    Model 9.1 Hospice in the Veterinary Hospital Setting 110

    Model 9.2 Hospice with Specialized Mobile Veterinarians 112

    Model 9.3 Animal Hospice Case Managers 113

    Model 9.4 Animal Hospice Sanctuaries/Rescues 114

    Practicalities of Starting an Animal Hospice Service 114

    Telehealth as a Bridging Component for all Models 117

    Conclusion 118

    References 119

    Part II Patient Care 121

    10 Cancers in Dogs and Cats 123
    Alice Villalobos, DVM, FNAP and Betsy Hershey, DVM, DACVIM (Oncology), CVA

    Approach to End- of- Life Cancer Patients 124

    Tumors of the Skin and Soft Tissues 124

    Canine Lymphoma 125

    Head and Neck Cancer 126

    Oropharyngeal and Neck Tumors in Dogs and Cats 126

    Nasal Passage Cancer 127

    Brain Tumors 127

    Cancer of the Skeletal System 128

    Abdominal Tumors 129

    Hemangiosarcoma in Dogs 129

    Transitional Cell Carcinoma 129

    Hepatic, Pancreatic, Intestinal, Adrenal, and Renal Cancer 130

    Chest Cavity Tumors 130

    Palliative Cancer Medicine 131

    Advances in Noninvasive Technology for the Diagnosis of Cancer 134

    Summary 135

    Conflicts of Interest 135

    References 135

    11 Integrative Therapies for Palliative Care of the Veterinary Cancer Patient 138
    Betsy Hershey, DVM, DACVIM (Oncology), CVA

    Nutrition and Food Therapy 138

    Herbs and Supplements 141

    Herbal Supplements 141

    Antioxidants 143

    Medicinal Mushrooms 143

    B Vitamins 143

    Digestive Enzymes 144

    Probiotics 144

    Vitamin d 144

    Omega- 3 Polyunsaturated Fatty Acids (PUFAS) 145

    Curcumin 145

    High Dose IV Vitamin C Therapy 145

    Acupuncture 146

    Manual Massage Therapies 147

    Energy Therapy (Biofield Therapy) 148

    Sound Therapy 148

    Reiki, Therapeutic Touch, and Healing Touch Therapies 148

    Ozone Therapy 148

    Hyperbaric Oxygen Therapy 150

    Cannabis and Cannabidiol (CBD) Oil 151

    Essential Oils 154

    Homeopathy and Homotoxicology 155

    Chiropractic 156

    Photobiomodulation Therapy (PBM) 157

    Summary 158

    References 158

    12 Chronic Kidney Disease 163
    Shea Cox, DVM, CHPV, CVPP and Christie Cornelius, DVM, CHPV

    Description of Disease 163

    Disease Trajectory 163

    Clinical Manifestations of Disease 163

    Management 164

    Management of Factors that Accelerate Chronic Kidney Disease Progression 164

    Dehydration 164

    Nonregenerative Anemia 164

    Systemic Hypertension 165

    Proteinuria and Activation of the Renin–Angiotensin–Aldosterone System 165

    Renal Secondary Hyperparathyroidism 165

    Symptomatic, Supportive, and Palliative Therapies 166

    Oral Ulcerations and Uremic Gastritis 166

    Nausea/Vomiting 166

    Constipation/Obstipation 167

    Loss of Appetite 167

    Urinary Tract Infection 167

    Hyperphosphatemia 168

    Hypokalemia 168

    Seizures 168

    Dietary Considerations 168

    Other Comfort Measures 168

    Conclusion 168

    References 169

    13 Congestive Heart Failure 171
    Shea Cox, DVM, CHPV, CVPP and Christie Cornelius, DVM, CHPV

    Description of Disease 171

    Disease Trajectory 171

    Clinical Manifestations of Disease 171

    Palliative Management 172

    Pulmonary Edema/Cardiac Function 172

    Diuretics 173

    Ace Inhibitors 173

    Positive Lonotrope, Vasodilator 174

    Calcium Channel Blocker 174

    Pleural and Abdominal Effusion 174

    Hypokalemia 174

    Prerenal Azotemia 174

    Balancing Renal and Cardiac Disease 174

    Coughing 175

    Respiratory Distress 175

    Aortic Thromboembolism 175

    Dietary Considerations 176

    Heart- Gut Interactions in Heart Failure 176

    Other Considerations 176

    Conclusion 176

    References 176

    14 Respiratory Distress 178
    Cheryl Braswell, DVM, DACVECC, CHPV, CHT-V, CVPP

    Airway Collapse 178

    Description 178

    Trajectory/Prognosis 179

    Manifestations 179

    Management 179

    Pharmacologic 179

    Physical 179

    Nutritional 180

    Surgery 180

    Brachycephalic Airway Obstruction Syndrome 180

    Description 180

    Trajectory/Prognosis 180

    Manifestations 181

    Management 181

    Pharmacologic 181

    Physical 181

    Nutrition 181

    Surgery 181

    Airway Inflammation 181

    Description 181

    Trajectory/Prognosis 182

    Manifestations 182

    Management 182

    Pharmacologic 182

    Physical 183

    Nutritional 183

    Pneumonia 183

    Description 183

    Trajectory/Prognosis 183

    Manifestations 183

    Management 183

    Pharmacologic 183

    Physical 184

    Nutritional 184

    The Suffering of Dyspnea: Palliative Care 184

    References 185

    15 Gastrointestinal Conditions 186
    Shea Cox, DVM, CHPV, CVPP and Christie Cornelius, DVM, CHPV

    Inflammatory Bowel Disease 186

    Description of Disease 186

    Disease Trajectory 186

    Clinical Manifestations of Disease 186

    Palliative Management 186

    Medical Support 186

    Immunosuppressive Therapy 186

    Antibiotic Therapy 187

    Additional Support Therapy 187

    Nutritional Support 188

    Fecal Microbial Transplantation (FMT): The Ultimate Probiotic 188

    Pancreatitis 188

    Description of Disease 188

    Disease Trajectory 188

    Clinical Manifestations of Disease 189

    Palliative Management 189

    Medical Support 189

    Analgesia 189

    Antiemetics 189

    Antibacterials 189

    Immunosuppressants 189

    Subcutaneous Fluid Therapy 189

    Nutritional Support 189

    Cholangitis/Cholangiohepatitis Syndrome 190

    Description of Disease 190

    Disease Trajectory 190

    Clinical Manifestations of Disease 190

    Palliative Management 190

    Medical Support 190

    Antimicrobial Therapy 190

    Immunosuppressive Therapy 190

    Analgesia 191

    Antiemetics 191

    Support Therapy 191

    Subcutaneous Fluid Therapy 191

    Nutritional Support 191

    Conclusion 191

    References 191

    16 Musculoskeletal Disorders 193
    Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, MSTCVM

    Osteoarthritis 193

    Description 193

    Trajectory/Prognosis 194

    Manifestations 194

    Management 195

    Cranial Cruciate Ligament Pathology 197

    Description 197

    Trajectory/Prognosis 197

    Manifestations 197

    Management 197

    Medical Management 198

    Surgical Management 198

    Strains, Sprains, and Myofascial Pain 199

    Description 199

    Trajectory/Prognosis 199

    Manifestations 199

    Management 199

    Coxofemoral Luxation 200

    Description 200

    Trajectory/Prognosis 200

    Manifestations 200

    Management 200

    Fractures 201

    Description 201

    Trajectory/Prognosis 201

    Manifestations 201

    Management 201

    Conclusion 201

    References 202

    17 Nervous System Disease 204
    Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, MSTCVM

    Intervertebral Disc Disease 204

    Description 204

    Trajectory/Prognosis 205

    Manifestations 205

    Management 206

    Cervical Spondylomyelopathy 207

    Description 207

    Trajectory/Prognosis 208

    Manifestations 208

    Management 208

    Fibrocartilagenous Embolic Myelopathy 208

    Description 208

    Trajectory/Prognosis 209

    Manifestations 209

    Management 209

    Vestibular Disorders 209

    Description 209

    Trajectory/Prognosis 210

    Manifestations 210

    Management 210

    Laryngeal Paralysis/Geriatric Onset Laryngeal Paralysis Polyneuropathy 211

    Description 211

    Trajectory/Prognosis 211

    Manifestations 211

    Management 211

    Degenerative Myelopathy 212

    Description 212

    Trajectory/Prognosis 213

    Manifestations 213

    Management 213

    Disorders of Micturition/Urination 214

    Description 214

    Trajectory/Prognosis 214

    Manifestations 214

    Management 214

    Bladder Is Difficult or Cannot Be Expressed 215

    Bladder Can Be Expressed with Effort 215

    Straining to Urinate with Spurts of Urine Produced 215

    Bladder Easily Expressed with Continuous Leakage 216

    Urine Leakage when Urine Accumulates 216

    Ancillary Therapies for Micturition Disorders 216

    Conclusion 216

    References 216

    18 Cognitive Dysfunction 219
    Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, MSTCVM

    Description 219

    Trajectory/Prognosis 220

    Manifestations 220

    Management 221

    Client Education and Prevention 221

    Behavior Modification and Environmental Enhancement 221

    Diet Modification 222

    Supplements 222

    Alternative Care 223

    Pharmaceutical Interventions 223

    Conclusion 224

    References 225

    19 Pharmacology Interventions for Symptom Management 227
    Shea Cox, DVM, CHPV, CVPP

    Introduction 227

    Pain 227

    Clinical Signs of Pain 227

    Behavioral Indicators of Pain 227

    Pharmacology for Pain Management 228

    Nonsteroidal Anti- Inflammatory Drugs 228

    Glucocorticoids 229

    Acetaminophen 229

    Opioids 229

    Tricyclic Antidepressants 231

    Serotonin- Norepinephrine Reuptake Inhibitors 232

    Anticonvulsants 232

    N- methyl- d- aspartate Receptor Antagonists 232

    Monoclonal antibodies 233

    Pharmacologic Protocols 233

    Assessing Response to Treatment 234

    Anxiety 234

    Dysphoria 236

    Weakness or Fatigue 237

    Respiratory Symptoms 237

    Dyspnea 237

    Cough 239

    Nausea and Vomiting 239

    Anorexia and Cachexia 240

    Dehydration 241

    Constipation 241

    Oral Health 242

    Ulcers 242

    Dry Mouth (Xerostomia) 242

    Conclusion 242

    References 242

    20 Physical Medicine and Rehabilitation for Hospice and Palliative Care Patients 245
    Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, MSTCVM

    Physical Medicine vs. Physical Rehabilitation 245

    Considerations for Physical Medicine with Hospice and Palliative Care Patients 245

    Assistive Devices: Priority in Hospice Care 247

    Slings and Harnesses 247

    Straps and Bands 248

    Protective Footwear 248

    Support of Joints: Orthotic Devices 249

    Support for Paralysis/Pararesis: Carts and Drag Bags 250

    Four Simple but Important Manual Therapies and Therapeutic Exercises 250

    Range of Motion 250

    Assisted Standing and Walking 251

    Proprioceptive and Balance Techniques 251

    Massage and/or Tui-na 252

    The Role of Acupuncture for Hospice and Palliative Care Patients 252

    Innovative and Noninvasive Techniques 254

    Kinesiology Taping 254

    Extracorporeal Magnetotransduction Therapy: EMTT 257

    Extracorporeal Shockwave Therapy 257

    Targeted Pulsed Electromagnetic Field Therapy 258

    Other Therapeutic Modalities for Hospice and Palliative Care Patients 259

    Thermal Modalities 259

    Photobiomodulation Therapy (also known as Laser Therapy) 260

    Pulsed Signal Therapy 261

    Electrotherapy 261

    Therapeutic Ultrasound 262

    Manual Therapy/Medical Manipulation/Chiropractic Care 262

    Conclusion 263

    References 263

    21 Integrative Medicine in Animal Hospice and Palliative Care 265
    Kristina August, DVM, GDVWHM, CHPV

    Terms 265

    Going Mainstream 266

    Safety and Adverse Reactions 267

    Healing Philosophies 268

    Nutritional Supplements 269

    Herbal Medicine 269

    Essential Oils 271

    Other Therapies 272

    Ensuring Quality of Life 273

    Reliable Choices and Client Education 273

    Conclusion 274

    Educational Opportunities 274

    References 274

    22 Nursing Care for Seriously III Animals: Art and Techniques 278
    Shea Cox, DVM, CHPV, CVPP and Mary Ellen Goldberg, CVT, LVT, SRA-retired, CCRVN, CVPP, VTS-lab animal-retired, VTS-Physical Rehabilitation-retired, VTS-anesthesia/analgesia-Honorary

    Introduction 278

    Nurses’ Medical Roles 279

    Intake 279

    Planning of Care 279

    Ongoing Monitoring and Assessments 279

    Frequency of Assessments 279

    Parameters of Assessments 279

    Assessment of Pain 280

    Pain Scales 280

    Assessment of Other Signs of Discomfort 282

    Assessment for Dehydration 282

    Assessment of Medication Administration 282

    Assessment of Mobility 282

    Assessment of Mental and Emotional Status 283

    Delivery of Care: Nursing Care Considerations 284

    Comfort for the Patient 284

    Oral and Ocular Comfort 284

    Nutrition 286

    Hydration 287

    Treating Fluid Deficit (Dehydration) 287

    Maintenance Fluids Administration 288

    Calculating Fluid Deficit 288

    Hygiene 288

    Bedding 288

    Environment 289

    Mobility 289

    Range of Motion (ROM) 289

    Transitions 290

    Standby Assisted Standing 290

    Weight Shifting Exercises 290

    Assisted Standing Exercises 290

    Aids for Assisted Standing 290

    Mobility Carts 290

    Nursing Care for Recumbent Patients 290

    Urination 291

    Defecation 291

    Respiration 291

    Skin Care 292

    Mobilizing the Recumbent Patient 292

    Nurses as Advocates and Educators 292

    Nurses’ Role as Advocates for Patient and for the Caregiver 293

    Nurses’ Role as Educators 293

    Awareness of Signs of Pain 294

    Hygiene and Safety 294

    Death and Dying 295

    Conclusion 295

    References 296

    Further Reading 298

    23 Comfort Care During Active Dying 299
    Gail Pope and Amir Shanan, DVM

    Natural Death and Euthanasia 299

    Goals of Caring for the Dying Patient 301

    Advance Preparation and Education of Caregivers and Hospice Team 301

    Desirable Environment of Care 302

    Prognostication 303

    Changes During Early and Late Stages of Active Dying 303

    Available Information 303

    Changes During Early Stages of Active Dying 303

    Physical Changes 303

    Behavioral Changes 304

    Indications of Pain 304

    Changes During Late Stages of Active Dying 305

    Behavior, Sleeping Pattern, Responsiveness 305

    Respiration 305

    Eyes, Mucus Membranes, Jaw, and Extremities 306

    Muscle Twitching, Stretching, and the Agonal Position 306

    Odor 306

    Summary 306

    At the Time of Death 306

    The Different Types of Active Death 308

    Managing Clinical Signs During Active Dying 309

    Management of Pain 309

    Management of Anxiety and Agitation 310

    Fatigue and Weakness 310

    Loss of Ability to Swallow 311

    Respiration 311

    Cardiac Dysfunction and Renal Failure 311

    Diminished Skin Vitality 311

    Mucosal and Conjunctival Care 312

    Incontinence 312

    Administration of Medications, Fluids, and Food 312

    Administration of Fluids 313

    Administration of Food 314

    Administration of Medications 314

    Summary 315

    References 315

    24 Euthanasia in Animal End- of- Life Care 318
    Kathleen Cooney, DVM, CHPV, DACAW

    Decision- Making for the Animal Hospice Patient 318

    Advance Preparation and Education of the Professional Team 319

    Advance Preparation and Education of Caregivers and Family 321

    Euthanasia Setting: Desirable Environment of Care 323

    Euthanasia Techniques and Criteria 324

    Intravenous Injection 325

    Intracardiac Injection 325

    Intraperitoneal Injection 327

    Intrahepatic Injection 328

    Intrarenal Injections 329

    Variability and Unpredictability 330

    References 331

    Part III Caregiver Needs: Providing Support 333

    25 Caregivers’ Emotional Burden: Understanding, Acknowledging, and Addressing Caregivers’ Emotional Burden 335
    Amir Shanan, DVM

    Caregiving Experience 336

    The Mental Health Impact of Caregiving 339

    Supporting caregivers’ Emotional Needs 340

    The Role of a Licensed Mental Health Professional 343

    Qualified Mental Health Professionals 345

    Summary 346

    References 347

    26 Caregiver Burden in the Companion Animal Owner 349
    Mary Beth Spitznagel, PhD and Mark D. Carlson, DVM

    What Is Caregiver Burden? 349

    A Word About Research Data, the Terminology Used, and this Article’s Audience 349

    Caregiver Burden Is Present in Owners of Seriously Ill Companion Animals 350

    How Caregiver Burden Differs from Other Client Experiences in this Context 350

    How Does Caregiver Burden Affect the Veterinary Client? 351

    Impact of Caregiver Burden on the Client 351

    Impact of Caregiver Burden on the Patient 352

    Research- Based Suggestions for Interacting with the Burdened Owner 352

    Understand the Owner’s Perspective 352

    Collaborate on the Care Approach 353

    Lighten the Load 353

    One Size Does Not Fit All: Toward Individualized Client Interactions 354

    Interacting with the Distressed Client 354

    Interacting with the Resilient Client 355

    Interacting with the Non- Distressed Client 355

    Interacting with the “Other Influences” Client 355

    More than Compassion Fatigue: When Client Burden Transfers to the Clinician 355

    The Burden Transfer DANCE 356

    Conclusions 357

    References 357

    27 Addressing Spiritual Needs of Caregivers 360
    Carol Rowehl, LVT, MAR, STM

    Spiritual Needs of Caregivers 361

    Spiritual Distress 362

    Taking a Spiritual History 363

    When to Call in the Experts (and Who Are the Experts?) 364

    Spiritual Questions Unique to Veterinary Practice and Hospice and Palliative Care 366

    Including a Chaplain on the Interdisciplinary Veterinary/Hospice Team 367

    Resources 370

    References 371

    28 Factors Contributing to the Decision to Euthanize Pet Dogs and Cats 374
    Nathaniel Cook, DVM, CVA, CVFT, CTPEP and Beth Marchitelli, DVM, MS

    Introduction 374

    Pet Factors: Symptoms and Clinical Signs that Affect Quality of Life 374

    Appetite and Weight Loss 375

    Appetite 375

    Weight Loss 377

    Elimination Disorders 377

    Impaired Mobility 379

    Sensory and Cognitive Decline 380

    Dyspnea and Respiratory Compromise 381

    Perception of Pain 382

    Pet Factors: Severe Illness Diagnosis 382

    Cancer 382

    Organ Failure: Congestive Heart Failure 383

    Endocrine Disorders: Diabetes Mellitus 384

    Pet Owner Factors: Psychosocial Factors of Caregiving 384

    Conclusion 385

    References 385

    29 Supporting Other Needs 389
    Shea Cox, DVM, CHPV, CVPP and Mary Ellen Goldberg, CVT, LVT, SRA-retired, CCRVN, CVPP VTS-lab animal-retired, VTS-Physical Rehabilitation-retired, VTS-anesthesia/analgesia-Honorary

    Caring for the Caregiver: Addressing Emotional and Physical Needs 389

    Maintaining Self- Care 390

    Maintain Personal Nutrition and Sleep 390

    Engage in Exercise 390

    Make Time for Relaxation 390

    Time Considerations of Hospice Care 391

    Managing Time Commitments of Care 391

    Tips for Balancing Caregiving with Ongoing Responsibilities 391

    Understanding the Physical Labor of Care 391

    Utilizing Proper Body Mechanics During Delivery of Care 392

    Environmental Considerations of Hospice Care 393

    Assessment of the Physical Space 393

    Household and Environmental Modifications 393

    Financial Considerations of Hospice Care 393

    Cost of Medications 394

    Cost of Diagnostics 394

    Cost of Other Healthcare Providers 394

    Cost of Environmental Modifications 394

    Cost of End- of- Life Care 394

    Helping to Defer Costs of Hospice Care 395

    Pet Health Insurance 395

    Equipment Rental, Recycling, and Reduced Cost Programs 395

    Creating a Memorial Fund 395

    Creating a Donation Bank 395

    References 396

    Further Reading 396

    30 Aftercare 398

    Coleen A. Ellis, CT, CPLP

    Hospice Options and Accompanying Rituals 398

    Emotional Support: Honoring the Journey 401

    Assisting Children, Other Pets, and Family Members in Their Journey 402

    After- Death Care Options 402

    Summary 406

    References 406

    Index 407

  • Amir Shanan, DVM, is the Founding President of the International Association for Animal Hospice and Palliative Care and a Founding Partner of the Animal Hospice Group. He owns Compassionate Veterinary Hospice, a veterinary practice dedicated to end-of-life care, in Chicago, Illinois, USA.

    Jessica Pierce, BA, MDiv, PhD

    Is a bioethicist and Faculty Affiliate at the Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, in Aurora, Colorado, USA.

    Tamara Shearer, DVM, CCRP, CVPP, CVA, MSTCVM

    Owns Shearer Pet Health Services and Smoky Mountain Integrative Veterinary Clinic in Sylva, North Carolina, USA, and serves on the faculty of Chi University.