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Hospice pet care and compassionate home euthanasia

Advanced Care Directives

So now you’re a caretaker of a hospice pet. It’s decided. This is how you have chosen to design the end of your pet’s life – comfort care, at home, supported, empowered and with moments of peaceful recognition that this phase of your pet’s life can be just as precious as the beginning. Without judgement you step into the world of animal caregiving and find out the road is paved with many milestones that when you are supported and equipped to deal with, don’t turn your world or your pet’s care upside-down. One of those milestones can be an Urgent Care Visit.

In the event of an Urgent Care Visit with your pet during hospice care, there are some things that are worth considering before that time that can help streamline the visit and make it less stressful emotionally, physically and financially. It is never too early to consider what your parameters are, document them and instruct any other family member or caretaker what these might be should they be involved in caring for your pet, particularly in your absence. Deciding ahead of time how you want things to look is advantageous to everyone and brings a peace of mind during the caregiving days and months. It may seem slightly clinical or even morose to think about these situations, but the reality is they happen everyday and how equipped we are and how we react to them can make all the difference.  

What Constitutes An Urgent Care Visit And What Choices Are In Pet’s Best Interest?

At the time of the pet hospice consultation you will be educated in the many ways you can make life comfortable for your pet during hospice. No longer searching for a cure and utilizing professionals trained in the art of pet hospice and palliative care, you can feel more relaxed and empowered to be right in the present moment with your beloved family companion, knowing you are doing all you can and that is plenty.

During the consultation the topic of an urgent care visit during pet hospice can be raised and should be. What would you do? Who do you contact? What lengths are you willing to go? Where is the cut-off for diagnostics and how would you know? Would you be willing to decide to euthanize at the urgent care should that be the next indicated step?

None of these questions should be deemed as being too clinical, morose or taboo. It’s not as if you can put off the inevitable end of life moment for your pet, but you can and should know what is available to you, what your wishes are and what are the logical steps to take. Emotions can run high in any emergency and deciphering wishful thinking from science and logic and also personal preferences, can make all the difference in traveling the path of least regrets and the legacy you wish to leave behind for your pet.

It is important to understand when your pet needs to visit the emergency vet clinic and when your pet hospice veterinarian is able to simply help make your pet more comfortable. Discussing these guidelines with your pet hospice veterinarian is recommended but below is a brief guide to keep in mind.  

ER Symptom Guide:
  • Difficulty breathing, which may present as blue or pale gums, coughing with foamy or pink frothy liquid, panting constantly or stretching the head and neck out while breathing. Diseases that may progress to difficulty breathing include: congestive heart failure, lung cancer or other canine cancers that may spread (metastasize) to the lungs, anemia, asthma, pneumonia and megaesophagus predisposing a dog to pneumonia.
  • Constant coughing
  • Bloated abdomen. Diseases such as heart failure, spleen or liver cancer and gastric dilation and volvulus or GDV may present with a bloated abdomen
  • Non productive retching or gagging is the most common sign of GDV
  • Pale gums (a dog’s or cat’s gums should be pigmented meaning dark black or the same pink color as your gums. If they appear white or pale pink this may mean there is severe anemia or blood loss.)
  • Elevated heart rate (Resting dogs should not have heartbeats over 110 beats per minute in a large dog or 150 in a small dog. Lay pet along their side and place your hand over the heart located behind the shoulder blade along the chest. Count each beat in 6 seconds then multiply by 10. You should practice this a few times at home so that you become familiar with what is normal for your pet. You may also place fingers along the inner portion of the hind leg against the abdomen to feel a pulse. Either way is used to check the heart rate.
  • Elevated respiratory rate (>60 bpm while resting)
  • Yellow gums. This is a sign of severe liver disease or a condition called IMHA where the body is destroying the red blood cells causing severe anemia
  • Vocalizing in pain
  • Dragging legs or unable to move may be a sign of a fractured leg, neurologic disease or blood clot (Aortic Thromboembolism, “Saddle Thrombosis”) in cats.
  • Non responsive or severe lethargy
  • Collapse
  • Tremors or seizures
  • Fever  (Dogs and cats should have a temperature between 100.5 and 102.5 F.) If the temperature is below 98 or over 103 a veterinary emergency clinic visit is needed. To check a temperature lubricate the end of a rectal thermometer with a water-soluble lubricating jelly or petroleum jelly such as K-Y jelly or Vaseline yellow petroleum jelly and gently insert in the rectum. Wait the time recommended by the thermometer, remove it and read results. For digital thermometer: leave in until it beeps and check and record the temperature. For non-digital thermometer: wait 2 minutes after inserting before checking temperature.
  • Toxin ingestion
  • Male cats making frequent trips to the litterbox, straining or non productive attempts to urinate

If these symptoms are noted, your pet hospice veterinarian should be contacted immediately or an emergency vet clinic visit is needed. Your pet hospice veterinarian should be contacted if stabilization and care is not your wish and you have elected in home pet euthanasia in the event of deterioration. If your pet hospice veterinarian is not available for an immediate appointment an emergency visit is recommended.

What To Expect At The Emergency Vet Clinic:

You may discuss with family ahead of time if CPR or DNR (Do not resuscitate) would be your wishes in an emergency.

  • If you are faced with heading to the emergency vet clinic there are some protocols to understand ahead of time and preparing for a possible emergency is best to help avoid additional stress for both you and your pet. Having your local emergency veterinary hospital’s address and phone number within reach and programmed into your phone is a good idea. You may want to have google map directions printed and available just in case and consider calling ahead if you decide to go to the pet hospital so the staff may anticipate your arrival.
  • When you arrive you will be asked to complete an intake and history form. Your pet will be assessed to determine if they are stable. A technician or assistant may take vital signs including temperature, heart rate, breathing rate, gum color etc within the first 5-15 minutes of your arrival. If your pet is in visible distress, a veterinary team member may ask your permission to bring your pet directly to the ER treatment area to be assessed by a veterinarian. They may ask if an initial amount is authorized for stabilization and have you sign a form authorizing this treatment so pain relieving medications, shock therapy or CPR may be performed if needed.
  • A veterinarian will examine your pet in your presence in an exam room if stable or behind closed doors in the treatment area if you pet is in distress or critical. The veterinarian will take a thorough history about your pet. You may be prepared by having key information already available such as a brief summary of your pet’s illness and even medical records and labs from your veterinarian. Having a list of medication names and doses, frequency of administration is helpful. The veterinarian will present a medical plan after gathering information from the physical exam and history.
  • The reason that a critical pet is taken to the treatment area without the owner is to facilitate quick evaluation and treatment for the pet, and that the owner cannot come with them because of 1) liability issues for the hospital and 2) there are often other procedures/treatments being carried out in the room so it must be restricted to employees working with the pets.
  • The plan will involve diagnostics (lab tests) and treatment. It is important to understand that often some diagnostics are needed for a veterinarian to be able to help make your pet more comfortable. For example:  blood pressure, pulse oximetry to measure oxygen levels if your pet is having difficulty breathing, PCV/TS if anemia is suspected, brief ultrasound to check for internal bleeding or a blood glucose level. It is important to stress to your veterinarian that your ultimate goal is comfort and a peaceful transition. Extensive diagnostics are not part of your pet hospice plan. Diagnostics and treatment should be limited to those only necessary to alleviate pain and suffering.
  • Recommended treatment options may include: oxygen, fluid therapy, thoracocentesis (removing fluid or air from the chest) or blood transfusion among many others. You may discuss with your family and pet hospice veterinarian ahead of time what extent of treatment you feel comfortable with at this stage.
  • Hospitalization may be recommended. It is helpful to decide whether your family prefers to have your pet transition or be stabilized if possible then discharged for in home pet  euthanasia ahead of time. It is important to understand your pet’s prognosis. Your family should discuss with the veterinarian a prognosis so you may understand if this is a setback or if there has been a significant deterioration affecting your pet’s quality of life so you may make an informed decision. You may discuss with the veterinarian if your preference is to have your pet transition at home and if this is possible or against medical advice.
  • Unfortunately, there is often much time spent waiting at the emergency veterinary hospital. This is not unusual although not ideal. Understanding the staff often are triaging multiple cases or need time to gather information for your pet may help ease some of your frustration.
Who Are The People On Your List That You Wish To Have With You?

Having a list of people you trust with your pet and who are involved with the daily care – family, neighbors, pet sitters, holistic health care professional, etc. would be wonderful to have on your team of trusted people in moments of need, decision making and even when you as the primary caretaker need a rest. This also helps prevent caregiver burnout, which can compromise the level of care for your animal. So thinking about this list ahead of time is a good thing.

Can You Call Your Hospice Vet While You Are At The Urgent Care?

After your hospice consultation with a Paws Into Grace Veterinarian, you will know what is available to you and your pet with the care you have chosen. It is always beneficial to have somebody with you at any appointment – urgent or otherwise, and an urgent care visit is no exception. With the education, support and knowledge that you will receive from Paws Into Grace, you will feel more empowered should this situation arise and you will know what your choices are and which way to proceed. After the appointment is a good time to contact your pet hospice veterinarian and combine forces for an elevated level of care for your pet. A Paws Into Grace veterinarian makes every effort to contact you in the event of an emergency but we may not be available after hours. Discussing what to expect and guidelines of care ahead of time with our team is recommended to help guide you in the event of an emergency.

Euthanizing Your Pet At Urgent Care – Yes Or No And Your Aftercare Options

For most people who are Paws Into Grace pet hospice clients, their preferred end of life scenario for their pet is at home, wrapped in the arms of their loved ones, peaceful and supported. So what happens when the option to euthanize is given at the urgent care?

After your pet is stabilized you might choose to go home fully aware of what might happen on the drive or afterwards. If you decide to take this route, call Paws Into Grace and we will guide and assist you from that point going forward.

If your pet passes at the vet, you can still take them home and you can call Paws Into Grace and we will walk you step by step through your choices at that point for aftercare options.

You do not have to leave your pet at the emergency veterinary hospital if you do not want to. But if you do, it is important to ask those difficult questions regarding their aftercare. Every place is different and have different companies that they use and different protocols. We all want a dignified cremation/burial for our loved ones. So try your best to not shy away from these questions for the path of least regrets.

Individual, communal or mass pet cremations are your usual options. Pet burial is also an option but you may have to work directly with the pet cemetery for that choice which would entail having the pet picked up either from the urgent care/veterinarian practice or from your home. Paws Into Grace or the pet cemetery can assist you in this regard.

A home burial is also another option. There are things to consider beforehand which will make this option much easier on everyone. You need to own your home and many local authorities will not allow you bury a hamster in your garden, let alone a dog. So consider the following:

  • knowledge of your local laws for pet burial
  • finding the right spot
  • do you have help and the time factor/how quickly the grave has to be dug
  • the time of year and how hard the ground is (in CA, the ground is always hard)
  • if a move happens in the future how will the family cope emotionally?

It’s an empowering thing to know that any pressure you feel is an indicator of not being sure what to choose. This is a moment when you should use all the tools in your toolbox and be as sure as you can that  your decision is what is best, what you want and what you know to be right for you and your pet. All events arising from empowered decision making are much easier to cope with, particularly when healing from the loss.

Advanced Care Directive Resources:
ER Checklist & Plan
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