End of Life does not mean Life must End.
Storm was aptly named, she had been a force of nature her entire life. However, the first time I met her she was a simmering Storm, laid low by the bleeding mass in her spleen. The second time I met her, she greeted me at the door, hackles raised, barking, charging me a bit, a wild Storm! A completely different dog from the first time I met her. She was in animal hospice and we were controlling her pain and gave her a great quality of life until her cancer had metastasized to her brain and her bone and we helped her with gentle euthanasia. She lived 9 months past the initial diagnosis, far past when she was “supposed” to die.
People who have been given a terminal diagnosis do not stop living at the moment of diagnosis. They have several choices to deal with their disease to fulfill their life for as long as they are able. This can include life-prolonging care, limited care, and comfort care, more commonly known as palliative or hospice care. People often spend this last part of life, termed end of life stage, or the stage of end of life, doing things they have wanted to do, a bucket list for example. They may also be past the point in their disease process where they are able to go out and do a bucket list but they still are often engaged in life activities around their home and with their family.
As a palliative medicine veterinarian, I most often encounter animals who have been given a terminal diagnosis. A palliative medicine veterinarian does both comfort care and end-of-life care for patients and has additional training beyond veterinary school. I help those animals live as full and happy a life as they can with their terminal disease. This can mean that there is a cessation in curative medicine, no more tests, no more trips to the veterinarian’s office, often bringing in a house call veterinarian to help the family through comfort care. It can also mean for some, the same as for people, life-prolonging care, such as palliative radiation, or limited care, such as giving fluids or treating an abscess. It does not necessarily mean that the animal has to be euthanized at that time, there is often more a palliative medicine veterinarian can do to help keep the animal comfortable. Euthanasia is still an option and most palliative medicine veterinarians will perform euthanasia when it is time and is deemed appropriate by the team giving care of the pet.
The concerns that the family has may be the animal is in pain, or that the owners or the veterinarian has not perceived pain in the animal but thinks they are suffering in some other way. Most often it is pain and because chronic pain is much more difficult to assess in animals, the clinical signs may have been missed. However, if you ask human beings in the same condition, cancer for example, as they get farther into their disease process, they will report pain. With chronic pain in humans, the way you know about it, is the person who has chronic pain will tell you. With chronic pain in animals, since they can’t tell you directly, they show you in other ways. So many animals I see, have gotten off their nice cushioned beds and are now laying on the hard floor. They do this because pressure can help relieve pain, think of a person with back pain, they get the firmest mattress they can find because it helps relieve pain. Animals who pace at night, who stop eating, stop grooming, who get grumpy or have changes in their behavior, all could have chronic pain. (If you are reading this and notice any of these things, please bring them to the attention of your veterinarian.)
There are many things a palliative medicine doctor can do for your animal at the stage of end of life. End of life does not mean life has to end. If we can make them comfortable, they can go on living, and be engaged in life. If not, we can always help them have a gentle death. Consider finding a palliative medicine-trained veterinarian before you take the next step as your elderly animal approaches the end. #EndofLifeCare, #VeterinaryPalliativeCare, #Veterinary, #VeterinaryPalliativeMedicine