Hospice Care for Dogs and Cats

Comfort & Dignity for Your Elderly or Terminally Ill Pet

Hospice Care is an Active Process

Many times I have seen pets left to slowly deteriorate and die, without the benefit of hospice care.  These aren't neglected or abused pets.  Their owners are not cruel, heartless people.  These pets are loved, but their people have not been educated in the art of pet hospice care.  Hospice care is not simply watching your pet's condition worsen, standing by while all of the body systems shut down, one by one.  No, quite the opposite is true.  Hospice care is an active process in which the pet owner intervenes - sometimes in subtle ways, sometimes in quite dramatic ways - to ensure that the pet's last months, weeks, and days are comfortable and dignified.

Dr. Zaring's Fair Four

It is my belief that if one wishes to keep a terminally ill pet or a pet of advanced age (particularly a pet of advanced age that has one or more chronic conditions) alive, then that person should ensure that the pet has decent mobility, adequate nutrition, and is free of infection and pain.  This is fair to the pet.  If these basic needs cannot be met, then the pet does not have a good quality of life, and it is no longer fair to keep the pet alive.  Sadly, it is at that point that I believe a pet owner should consider humane euthanasia.  

1.  Mobility is Essential

While an old dog or cat is not going to hop around like he did in younger days, he still needs to be able to walk.  In most cases, reduced mobility is due to one of two problems:  weakness or pain.  An example of weakness leading to poor mobility is an old cat with kidney failure.  Kidney failure causes anemia - reduced production of oxygen-carrying red blood cells.  Anemia causes fatigue and weakness.  An old kitty in the advanced stages of kidney failure may need help standing, encouragement to walk, and special food & medications to increase strength.  An example of pain affecting movement is an old dog with advanced arthritis.  Painful joints make it too hard to move around, and the less the dog moves, the more stiff and painful his joints become.

Lack of mobility is a great source of anxiety for animals, and they can become depressed.  Your pet needs to be able to lie down in comfort, get up (even if it is with assistance), and walk at least a few steps.  Lying in the same position for long periods of time will make your pet stiff, further inhibiting his ability to move.  Also, lack of mobility predisposes animals to pneumonia and painful bed sores (infected skin ulcers).  

2.  Provide Adequate Nutrition

Old pets often do not eat well.  Many factors can contribute to poor appetites in older pets.  Some have bad teeth, others are in too much pain to eat, some have upset stomachs, and many old pets are just too exhausted to make the effort to eat.  You may need to provide your elderly pet with elevated food and water dishes, so he doesn't have to bend over to reach them.  An old pet may need to eat canned food, since it is easier to chew and swallow.  Food may have to be extra flavorful and served warm.  You may have to hand feed your dog or cat, encouraging her to eat each bite.  In the last stages of hospice care, you may have to feed your pet with a syringe or consider having your veterinarian place a feeding tube.  (Feeding tubes are not always the best option for the pet - but that's a discussion for another blog.)

3.  Treat & Prevent Infections

Infections are more common in old animals than in young animals.  Senior pets are prone to skin infections, urinary tract infections, and tooth infections.  Infections cause pain, and the infection can enter the blood stream and damage critical organs.  It is very important to have your veterinarian examine your senior pet closely, diagnose any active infections, and treat the infections appropriately.  

Part of your responsibility as your pet's hospice care provider is to take steps to prevent infections.  Keeping your pet clean and dry is your best defense against infection.  Check your pet's bedding several times a day for moisture.  Moist bedding must be replaced with dry bedding.  Old dogs and cats often cannot reach their bottoms to clean themselves after going to the bathroom.  You will need to use baby wipes or a damp washcloth to clean your pet's anal area.  If you have a girl dog or cat, you will need to make sure her vulva stays clean, so she doesn't develop a bladder infection.  Our senior pets need help with their coats too.  Regular brushing will help keep the hair from matting.

4.  Alleviate Pain

Our pets are people pleasers.  They want so badly for us to think that all is well, that they will hide their pain from us.  I could write an entire blog about recognizing pain in dogs and cats.  It is difficult.  As I'm typing this, I hear echos of pet owners telling me, "He doesn't seem to be in pain," and "She doesn't cry out or scream, so she must not be hurting."  Trust me, you don't want to know the horrific level of pain that is required to make a dog or cat scream.  Here is my rule of thumb:  If a condition is painful to a person, it is painful to a pet.  Crippling arthritis = painful.  Ulcerated skin tumors = painful.  Severe tooth decay = painful.  Cancer = painful.  Don't let your stoic pet suffer quietly with a painful ailment.  Ask your vet to assess your pet for pain and prescribe an appropriate pain management program for your pet.

My sunshine doesn't come from the skies,

It comes from the love in my dog's eyes.

~Unknown

Advanced & Complimentary Care may be an Option for Your Pet

Alright, I've covered the "Fair Four."  That is, my four essential aspects of hospice care:  maintain mobility, treat infection, keep your pet eating, and control pain.  I believe that these are the four areas that must be managed if you are choosing to keep your very old or terminally ill pet alive.  (The other choice is humane euthanasia - definitely a topic for a whole other blog.)

Where to take hospice care beyond the "Fair Four" is an unique, personal decision that you will have to make.  How a person approaches pet hospice care depends on many factors, including the person's view of animals, the person's view of pet ownership, the bond with the animal, the presence or absence of children in the household, the pet's temperament, ethical considerations, religious beliefs, and financial constraints.  Your veterinarian's job is to work with you to formulate a hospice plan that meets the basic requirements I outlined earlier in this blog AND that meets your personal expectations.

There is nothing wrong with doing basic hospice care.  It has been my experience that most pet owners want to maintain the "Fair Four" as long as they can, and then they want to have their pet peacefully euthanized in the comfort of the home.  This is perfectly acceptable.  

 Some people have the desire and the ability to provide advanced hospice care for their pets, and they have pets who are good candidates for advanced hospice care.  In those cases, I am happy to oblige.  Advanced hospice care can take many forms.  It may involve injection of fluids under the skin to maintain hydration, combinations of pain medications, slings or carts to improve mobility, prescription diets, feeding tubes, cutting-edge treatments, physical therapy, short hospital stays during flare ups, and even referral to veterinary specialists.  Also, some pets will benefit for complimentary veterinary care, such as vitamins, herbs, massage, acupuncture and chiropractic adjustments.  If you think that you and your pet are candidates for advanced hospice care, talk with your veterinarian.  He or she can work with you to develop a comprehensive plan for your pet.

Curbside Care & Dr. Zaring are here to help.

We all love our pets and wish they could live with us forever.  However, we also know all too well that our dogs and cats are merely visitors on our life journeys.  The time will come when a beloved pet needs your help in his or her final days.  It is your duty to return the great love your pet has given you by ensuring that the final days are filled with comfort, love and peace.  

If you need help determining your pet's quality of life, formulating a hospice care plan, or planning for your pet's end of life care, including in-home euthanasia, please call us at (317) 771-1952 or email us at curbsidecare@mail.com.  

In memory of Buck, who crossed the Rainbow Bridge 7/31/13.

Dental Care for Dogs & Cats

Dental disease is the most common ailment affecting our dogs and cats.

Unfortunately, dental disease often goes untreated.  Dental disease, also called periodontal disease, starts with mildly inflamed gums.  Eventually the inflammation worsens, painful infection sets in, and the bone surrounding the pet's teeth is eroded away - leaving loose teeth behind.

The good news: 

Dental disease can be prevented!

1.  Brush your pet's teeth.  Use a toothbrush designed to fit your dog's or cat's mouth.  Special pet-friendly tooth pastes are available that taste good to your pet and are safe for your pet to swallow.  Start slow - it may take several brushing sessions to get your pet used to the idea!  Daily brushing will slow plaque accumulation and can prevent periodontal disease.

2. Examine your pet's mouth regularly.  Carefully check your pet's mouth once weekly.  Become familiar with your pet's healthy mouth.  This will help you recognize signs of periodontal disease:

       -- bad breath

       -- red gums

       -- swollen gums

       -- yellow-brown plaque and tartar on teeth

3.  See your veterinarian regularly.  At your pet's annual or semi-annual wellness exam, your veterinarian will thoroughly examine your pet's mouth for signs of periodontal disease.  When caught early, periodontal disease can be successfully treated, preventing painful and potentially life-threatening consequences.

Learn More:  
http://www.vohc.org/
http://www.avds-online.org/
http://www.cvma.net/doc.asp?ID=2225

Indoor Cat Care

Vet Care for Indoor Kitties

One of the most common questions asked of veterinarians is, "Why does my indoor cat need to see the vet?"  Well, as it turns out, there are several reasons why your indoor cat should have regular veterinary care.

Plenty of cat diseases affect pampered, indoor cats.

Most of the illnesses that we veterinarians treat in our feline patients are illnesses that affect indoor and outdoor pets equally.  They are not contagious diseases.  They are conditions like heart disease, diabetes, overactive thyroid, arthritis and periodontal disease.

Medical problems faced by our pet cats are usually treatable, frequently preventable, and sometimes curable.  However, if we don’t look for illness, we won’t find it, and we can’t fix that which we do not know is broken.  That is why veterinarians stress the importance of having your indoor kitty examined at least once yearly.  For senior kitties (those over the age of 7 years), most vets prefer twice yearly physical exams.

It is during the physical exam that your vet will hear a heart murmur, find an enlarged thyroid gland, notice stiff hips, or find painful tooth decay.  Once the problem is identified, you and your veterinarian can form a plan to address the issue, improve your cat’s health, and extend his life.

My cat is acting just fine – he must be healthy.

This may be the biggest misconception among cat owners.  Most cats are going to act “just fine” until the day they finally are so incredibly ill that they just can’t hide their symptoms any longer.  At that point, the cat is usually so sick that treatment is complicated, expensive, and not usually effective.  

Hiding illness is a survival mechanism that has been selected for through thousands of generations.  In the wild, it is the slow, the weak, and the ill that are captured and killed.  Your pet cat has been pre-programmed to hide signs of illness at all costs.

If your cat is not going to report symptoms of disease to you, her trusted human care taker, then how are we going to know when something is wrong?  That’s right, through the physical exam.  Your veterinarian is trained to check all body systems – to examine your cat from nose to tail.  In my house call practice, the most common hidden illness discovered during a routine wellness exam is tooth decay.  Cats accumulate plaque and tartar, and this bacteria-ridden build-up quickly produces painful, infected gums.  The most commonly affected teeth are the pre-molars and molars – teeth hidden in the back of your cat’s mouth.  I have met few cats who would tolerate, and even fewer cat owners who would try to perform, a complete oral exam at home.  It is during the physical exam that I discover the decayed, loose, infected, even fractured teeth.  These findings are typically a shock to the cat owner because the cat is still “acting fine.” 

What’s this wellness testing all about?

Wellness testing, junior screen, senior screen, well cat blood work, yearly lab tests, that’s the jargon that you will hear.  By the time you hear the receptionist suggest it, the vet tech discuss it, and the doctor recommend it, you may think we are all trying to sell you a used car!  Well, technically, we are trying to sell you something – quality preventative health care for your cat.  The reason that the entire veterinary team stresses it so much is because of how important we think it is.  Remember what we just discussed?  Your cat is pre-programmed to act healthy at all times.  Well, that includes during the physical exam. 

Veterinarians recommend regular lab tests because there are illnesses that can be hidden from both the pet owner and the veterinarian.  Here is a typical scenario. 

I’m seeing Mrs. Doe’s 11 year old house cat, Jane, for her senior kitty check up.  My vet tech has asked Mrs. Doe all of the typical questions.  How’s Jane’s appetite?  How are her litter box habits?  Is she acting normal?  Mrs. Doe reports that Jane is “just fine.”  Jane drinks a lot of water, but that is “normal for her.”  During the exam, I find that Jane has lost a pound of weight since her last vet visit, six months ago.  However, she was always a little chunky, so she doesn’t appear too thin.  In fact, she looks good sans the extra pound.  The remainder of her exam is normal – all seems well.  I suggest wellness testing for Jane, especially in light of her weight loss, and my vet tech collects blood and urine samples.  When the results come back from the lab, I discover that Jane is not “just fine,” as Mrs. Doe thought.  In fact, she has chronic kidney disease.  She is drinking more and losing weight because her kidneys are not working properly.     

When caught in the early stages, before symptoms are noticed, many common cat conditions can be well managed.  For example, kidney disease can be managed for several years, diabetic cats can go into remission, and thyroid disease can be successfully treated.

Indoor cats need vaccines.

Yes, your indoor cat needs to be up to date on his vaccines.  Here are some reasons why.

#1.  Herd Health.  This is a term we borrow from our colleagues in large animal medicine – out there treating herds of cows and pigs and such.  However, you can think of a city’s or county’s or state’s cat population as a herd too.  (Same theory applies to a “herd” of dogs, or, for that matter, a “herd” of people!)  

In order to protect the herd from a particular virus, usually 75% to 95% of the herd must have immunity to that virus.  So, to protect all of the cats in the geographical area of Marion County, Indiana, about 85% of all cats need to be vaccinated.  There are feral and stray cats who don’t have a person to vaccinate them (and our friends at IndyFeral have not yet found them!).  Some cats are owned by people who do not understand the importance of vaccination, and so they aren’t vaccinated.  Other cats have chronic illnesses or immune system problems and cannot tolerate vaccinations.  Together, that’s probably approaching 15% of the local cat population (perhaps even a higher percentage).  Therefore, all of the cats who are healthy and live with responsible pet owners must be vaccinated in order to prevent an outbreak.  Vaccine programs only work if most of the population actually gets the vaccine.

#2.  Public Health.  Most of the diseases against which cats are vaccinated only affect cats.  However, Rabies Virus affects people too.  That makes vaccinating your cat against Rabies a public health issue.  To comply with Indiana law, your cat must have a current 1-Year or 3-Year Rabies vaccination.  The Rabies vaccine is safe, effective and inexpensive.  Rabies is contagious, preventable and almost always fatal.  You do the math.

#3.  Your Cat’s Health.  Are you really, positively, absolutely, certain that your cat will never come into contact with another cat or the germs from another cat?

Really?  Chances are, if you consider yourself the guardian or parent of one cat, you’re going to eventually bring home a second cat.  (Come on, admit it – you’d rescue a cute little stray kitten in a heartbeat!)  Also, how often has your cat tried to bolt out the back door to eat some grass?  Does your cat like to press her face right up against the screen of an open window?  And you probably have that one friend who has outside kitties that your kids just love to go play with.  Yes, you are busted.  Your indoor-only kitty is not as isolated as you may have thought.  Viruses can live on your hands, on your clothes, and in your yard.  Your cat’s risk may be low, but she is at risk.  Do yourself and your cat a favor, and have her vaccinated.  The feline ‘distemper vaccine’ (a vaccine against feline herpes virus, calicivirus and panleukopenia) and the feline Rabies vaccine only need to be administered to adult cats once every three years.  Again… safe, effective and inexpensive.