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Bonding With Patients, Veterinarians

Hospice care for animals is a bittersweet reminder of the strength of the human-animal bond that is possible.

Stars the greyhound dies peacefully at home after a visit to his veterinarian revealed osteosarcoma. He received pain medications and went home for a final goodbye and euthanasia.

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Ten years ago, the American Association of Human-Animal Bond Veterinarians (AAH-ABV) introduced or refreshed the concept of pet hospice to the veterinary profession. Dr. Caroline Schaffer of Tuskegee veterinary college was president of the AAH-ABV at the time.

She wanted to provide a platform for pet hospice. She asked me to present an oncologist’s version of pet hospice at AVMA 2000. Dr. Short asked me to give the profession my energy and perspective on end-of-life care.

The first thing that came to mind was to give it a new name. Instead of hospice, I came up with “Pawspice” (rhymes with hospice) because there is a big difference between human and pet hospice. Pet owners and their attending veterinarians are the decision makers at every step of the way, especially when it is the right time to end the hospice and use humane euthanasia.

Sadly, at the time of this writing, my husband and I are participating in hospice care for our dear friend Tony Soich. Tony is dying of tongue cancer associated with chewing tobacco and smoking cigarettes since he was a teenager. He has been battling tongue cancer and unable to eat for over a year. He is sustained with a feeding tube but won’t see his 50th birthday in August. Tony’s quality of life is gone, but his family and friends must watch him slowly decline and suffer.

In contrast, my best friend’s 12-year-old greyhound, Stars, slipped on the kitchen floor and broke his right tibia. X-rays showed a pathological fracture due to osteosarcoma. Stars received powerful pain medications and was taken home for tender, loving overnight farewells with family and friends. Stars was given the gift of euthanasia at home, surrounded by family, and he peacefully transitioned over the Rainbow Bridge about 24 hours after his ordeal began. 

Wonders of Pawspice

Society condones and encourages pet lovers to make decisions that minimize the suffering of terminal pets by giving them the gift of euthanasia. How fortunate for the pets! 

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The Pawspice philosophy does not want dying pets to continue living in frustration and pain. As Pawspice caregivers, we play an active role in evaluating quality of life and the risk-to-benefit ratio of palliative care for terminal pets.

When we can restore and maintain the various criteria that compose quality of life, pet hospice can be a meaningful and joyful time that gives family members an extended farewell with their beloved pets. Pawspice culminates with a reverent service for the dying pet as the family, with the help of their veterinarian, compassionately provides the gift of euthanasia. 

Some hospice pets have conditions that allow them to die peacefully and painlessly at home, and that is OK.

Over the past decade, veterinary medicine and pet caregivers have created and witnessed the pet hospice movement across the nation. It certainly requires a change of mindset for some practitioners while for others the concept of pet hospice seems very natural for them to adapt into practice. With the amazing advances in pain management— www.IVAPM.org —today’s veterinarians can provide improved professional approaches to palliative and end-of-life care for terminal pets.

In 2008 and 2009, the University of California, Davis, hosted the first and second International Symposiums on Pet Hospice. Kathryn Marrochino, Ph.D., founder of the Nikki Hospice Foundation—www.PetHospice.org—organized the symposiums. Pet hospice leaders and participants came together from throughout veterinary medicine and allied professions to share knowledge and to network.

An umbrella organization, the International Association of Animal Hospice and Palliative Care—www.IAAHPC.org—was formed by Dr. Amir Shanan of Chicago. His goal is to earn 501(c)(3) tax-exempt status for the group.

The next important step for the pet hospice movement is to become more defined and to set up standards of care and adopt a quality-of-life scale that is usable for all. The AVMA has published pet hospice guidelines that can be used for reference.

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AVMA Sessions

The Human-Animal Bond Sessions at AVMA 2010 will open at 8 a.m. Aug. 1 with the Leo Bustad Memorial Lecture. This year’s lecture will be presented by Brian Forsgren, DVM, the 2009 Bustad Companion Animal Veterinarian of the Year. Dr. Forsgren won the honor because of his generosity and his brilliant tiered remuneration system that accommodates homeless and disadvantaged pet owners as well as the regular clients at his Gateway Animal Hospital in Cleveland. 

The speakers for the all-day human-animal bond sessions are influential in the field of pet hospice. AAH-ABV President Tami Shearer, DVM, CCRP, and Amir Shanan, DVM, will focus on setting up pet hospice and palliative care protocols for every size of practice.

Robin Downing, a past president of the International Veterinary Association of Pain Management and the current president-elect of the AAH-ABV, will speak on pain management in the pet hospice setting. In addition, Dr. Downing, DVM, CCRP, Dipl. AAPM, will describe creative techniques for providing compassionate euthanasia services. 

I will speak on managing quality of life for pets with common chronic disease conditions and specific cancer types in the hospice setting. Tina Ellenbogan, DVM, and Ella Bittel, DVM, will present their viewpoints regarding natural death vs. euthanasia.

The human-animal bond sessions will close with a lively panel discussion dealing with issues that affect quality of life during pet hospice.

Veterinary Clinics of North America invited Dr. Shearer to edit a future publication on pet hospice. Meanwhile, feline practitioners may refer to Chapter 78, Feline Pawspice, in “Consultations in Feline Internal Medicine, Volume 6,” edited by Dr. John August, and Chapter 16c, Pawspice, in Withrow & MacEwen’s “Small Animal Clinical Oncology, Fourth Edition.”

In addition, Dr. Shearer has an excellent chapter on “Hospice and Palliative Care” in the Handbook of Veterinary Pain Management, second edition, edited by Gaynor and Muir.

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Business Meeting

The AAH-ABV holds its annual business meeting after the Sunday human-animal bond sessions. If you would like to attend the meeting and learn more about the human-animal bond, join the AAH-ABV at www.AAH-ABV.org.

The Society for Veterinary Medical Ethics will hold its all-day ethics sessions on Sunday, Aug. 1, at AVMA. The morning’s sessions are titled “Model Building: Student to Staff From the Ground Up” and will cover the struggles that students with various viewpoints experience regarding personal ethics and decision making during their veterinary school curriculum.

The morning sessions will discuss an ideal bill of rights and the afternoon sessions will discuss “Rights or Wrongs.” The SVME holds its annual meeting at the AVMA after the Sunday ethics sessions. If you would like to attend the meeting or learn more about approaching and dealing with ethical issues in practice, join the SVME at www.svme.org.

Alice Villalobos is a past president of the American Association of Human-Animal Bond Veterinarians and is president-elect of the Society for Veterinary Medical Ethics.

This article first appeared in the July 2010 issue of Veterinary Practice News. Click here to become a subscriber.

One thought on “Bonding With Patients, Veterinarians

  1. It takes courage to love….and even more to let them go…
    had a client at my Companion Animal Practise in Heidelberg Gauteng South Africa a year ago…also a beloved silver Greyhound.

    Educated awesome owners made the right decision at the right time and we all attended, family and vet, to salute a awesome pet….whose memory we all cherish..her running was but a symphony in motion.

    To all vets and pet owners out there…keep loving your pets and work with your caring veterinarian….It is ALL WORTH IT. Kindest Regards, Dr Elfrede Albert DCA, B V Sc

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