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In his amazing book “A Dirty Job,” Christopher Moore describes hospice workers as “benevolent Valkyries, midwives of the final light.”  Since I’ve transitioned to practicing hospice medicine, this is a description that resonates with me more than ever.  My practice involves many facets of pet care, including (and often focusing on) end-of-life care, mostly because that’s the one part of home veterinary care that people are most familiar with, but even when it comes to planning for euthanasia, there’s a place for hospice medicine.  In some ways, preparing for and easing the path to death is at the core of what we do.

Many people have both the desire to have their pet pass peacefully at home and the foresight to reach out to a veterinarian that provides in-home euthanasia when their pet is first given a terminal or incurable diagnosis – but most of them don’t realize that having a visit with, and establishing a relationship with a hospice veterinarian can help make preparing for that inevitable final visit much smoother and easier.

All too often, I’ve had clients approach me by phone or email to discuss their concerns about their pet’s condition and their hopes for a home death, but decline any house calls before then, only to wind up in a crisis situation where they have to take their critically ill pet to an emergency facility instead of having the peaceful home passage they envisioned.

There are many reasons people may not choose to have their ailing pet evaluated by a hospice veterinarian.  Often they feel like there’s nothing we can do, medically, to treat the animal.  In other situations, they’re afraid to confront the severity and permanence of their pet’s diagnosis until they have no other choice.  And lastly, they may feel that they’ve already done everything necessary by ascertaining that home euthanasia is an option, and checking on prices and procedures.

When you’re hoping for, or planning on, having a pet pass at home, it can help immensely to make an appointment with a hospice veterinarian as early in the course of events as possible.  Medicine is only a small part of what we do – much of our practice involves education, support, and planning.

We can help you get a deeper and more thorough understanding of your pet’s diagnosis, and teach you ways to recognize their levels of comfort and quality of life.  We can help provide a tentative timeline – while no doctor can see the future, we can at least help come up with an idea of how quickly symptoms are likely to progress, and when intervention may be necessary.  We can help you plan their passing, show you what signs to watch for to know when the right time has come, hopefully without ending up in an emergency situation, and we can help you find both the emotional and educational support that a caregiver needs.

Even in situations where we can’t prescribe medicine to treat an animal, hospice caregivers can help both people and their pets in their journey before, during, and after death.  Medicine is not limited to diagnoses and prescriptions, and support is not limited to the patients themselves.  We are here for everyone involved – let us help.

Working in hospice, palliative, and geriatric care, one of the most common challenges I see – and most emotionally traumatic – is that of pain and declining mobility in aging animals.  This is especially common in large-breed dogs, though it can happen in almost all species and breeds, and it can be one of the most difficult problems for owners to face.  When a beloved pet is still eating and alert and engaged with the family, but can no longer move around or handle getting into and out of the house, the possibility of having to euthanize an otherwise happy animal can be heartbreaking.  Likewise, it is difficult beyond words to watch a creature we love experience pain and loss of mobility, and not know what we can do to help them.

Luckily, as our pets live longer, veterinary medicine also learns new ways to help these creatures in their golden years.  There are a lot of new and emerging options to manage our elderly pets’ comfort and help them continue moving around and taking part in normal life activities, even as they face problems like arthritis, neurological disease, or muscle loss.

Pain management is always at the core of any such treatment plan, of course, and can take many forms.  Anti-inflammatory medications, additional oral pain medication, nutritional supplements, massage, and laser therapy are all tools in our arsenal for combating pain and discomfort in pets.  But sometimes even when an animal’s pain is well controlled, they still need help moving around.  Stiff joints don’t bend as far, weak legs can’t jump as high, and aging nerves aren’t as good at reminding our pets where their feet are at all times.

One of the most helpful tools for dogs with mobility problems is a support harness.  These are tools that allow a person to help the animal to stand up, add stability and support to their hind end, and assist with weight-bearing in difficult postures like climbing stairs or going to the bathroom.  In a pinch, a folded blanket or towel can serve a similar purpose, but for long-term use a harness made specifically for this purpose is more comfortable for the pet, less likely to lead to back injuries for the person doing the lifting, and provides better support.

Most aging dogs have more trouble with their hind end, so I recommend harnesses that have a handle either near the mid-back or two handles, one in front and one closer to the hips.  You may want to try on a few models to make sure you find one that fits and is comfortable for your pet.  In particular, for male dogs, you may want to make sure that any chest piece rests close enough to the body that it doesn’t become soiled during urination.

Ramps can also make a big difference in quality of life.  Whether it’s helping a small dog or cat get up to the sofa or a larger pet climb into a car or in and out of the house, ramps are easier to navigate than stairs.  Many pet supply stores sell such ramps, and for larger pets, ramps made for human use can work as well.

Inside the house, many older animals still have trouble standing and rising, especially on slippery surfaces.  For day-to-day situations where a harness may not be needed but some assistance would still be helpful, yoga mats are an excellent aid.  They’re fairly inexpensive, easily cleaned, can be moved to wherever a pet wants to wander, and provide a non-slippery surface that gives weak or stiff legs extra traction and make rising and walking easier.  Toe grips can also be very helpful – these are little plastic grips that you can slip over a dog’s toenails to help prevent skidding and slipping as they walk around.

Finally, for animals with extremely limited mobility or paralysis, there are carts that can be made to fit an individual pet to allow them to move around with the strength of their remaining functioning limbs.  While this may seem extreme, many pets can adapt quite well to a cart, and can have an excellent quality of life with the help of such a device.

As always, talk to your veterinarian to help determine what techniques and assistance devices would be most helpful to your pet, to help keep them active and comfortable for as long as possible.  With a little thought, TLC, and environmental modification, we can help keep your older pets active and mobile for a long time!

The more we learn about animals, the more we learn that their internal and emotional landscapes are far more complex than science originally imagined.  In particular, and most relevant to hospice and to those pet owners with elderly or ailing animals, we know now that grief is not an exclusively human emotion.  Our pets feel loss and emotional distress when another member of the family passes away – perhaps not in the same way that we do, but it affects them, and people who care for them often find themselves asking what they can do to help their pets through this difficult time.

The first thing to realize is that your pet may already be far more aware of the situation than you imagine.  Animals are highly perceptive, and aware of one another and changes in their housemates, often in ways that other humans in the household may not recognize.  Many dogs and cats will change their behavior towards an ailing pet, and this is normal.  You may see changes in their personality and their interaction with people in the house as well; all of these changes are part of the pet’s processing and adapting.

A lot of people ask me whether it helps to have other animals in the family present when a beloved pet is being euthanized, and my answer is that there’s no one right way to do this.  Every family, and every pet, is different.  If your pets are closely bonded, and are tolerant of strangers in the house that they won’t be distraught by the vet’s coming to visit, then it may be helpful to offer them the chance to be present – but I would never recommend forcing an animal to stay in the room.  If they choose to leave, let them.  And ultimately, if their presence is distressing to the people in the room (either because the pet is fearful, vocalizing, or creating a disturbance), it can be best to keep them out of the area.  If you’re concerned about them being left alone, having a friend stay with them in another part of the house can be helpful.

Another option, if you’ve chosen for a home euthanasia, is to have the vet come and spend a little time with both pets beforehand.  Going for a short walk, if the weather is cooperative, playing with favorite toys, or just letting the vet give them some of their favorite treats, can create a positive experience and memory for everyone involved.

Once your pet has passed, other animals in the household (just like people) may show changes in their behavior.  Loss of appetite, anxiety, seeking attention, or signs of confusion are all signs of grief and loss in pets.  In these situations, the most important thing you can do is keep their routine as normal as possible.  Keep the same diet and feeding schedule, interact with them in the same ways you did before, take them for walks in the same places or play with the same toys.  Stability is reassuring to our pets, just as it is to people.  Exercise can also be helpful – if you have a pet that seems particularly distressed at the loss of a housemate, extra walks, extra playtime, or extra training classes or sessions can help them through this difficult time.

And above all else, take care of yourself.  Our pets are highly aware of our emotions, and they feel anxiety and distress when we do.  Allow yourself to grieve, be gentle with yourself, and take care of your own emotional needs.  Your pets will take comfort as you do.

Of course, if your pet is not eating for more than a few days, if the behavioral changes are severe or not improving within a week, or if you are seriously concerned at any point, get them evaluated by your regular vet.  While grief is real, so are other health problems, and it’s important to make sure that we’re not missing a serious physical concern.  And, whenever you’re in doubt, call your vet.  We’re here to help you, and we can and will do our best to answer your questions and offer you the best advice for your situation – with medicine, there’s no one perfect, one-size-fits-all answer for everyone.

One of the most important details in taking care of pets, especially elderly pets or those with chronic illness, is controlling their pain.  And yet it can also be one of the most challenging aspects of caring for a pet as well.   As much as we love our pets, it can be difficult to know how they feel, and how to recognize pain when they can’t talk to us and tell us where – or how much – it hurts.

Recognizing pain in pets is difficult.  Animals don’t react to pain the way people do.  When you or I are in pain, we make noise.   We cry, or shout, or gasp.  We hold or touch the painful spot.  We draw attention to it.  We (usually) avoid doing things that we know will make the pain worse.  Animals react differently.  I have lost count of the times I’ve heard things like…

‘He’s not crying, so he must not be in pain.’

‘She’s limping, but I don’t think she’s in pain.’

‘He can’t be in pain; he’ll still run around the backyard sometimes.’

Dogs and cats – especially cats – are masters at hiding their pain.  Their nature is not to draw attention to any weakness or injury.  Also, most of the conditions we face, especially in aging pets, lead more to chronic pain than acute pain, which can build slowly and be very difficult to recognize.

So – how do you know if your pet is in pain?  What signs can you watch for?

-Limping or lameness

Any pet that is favoring a limb is likely in pain.  There are occasional nerve disorders that can cause changes in a pet’s gait, but those are much less common.  Even if your pet isn’t crying or whimpering when it walks, if it’s putting less weight on one leg, odds are it is in pain.

-Changes in activity or mobility

These can be more subtle than limping, but are still good clues.  If your dog is bunny-hopping when she runs instead of running normally; if your cat has stopped jumping up onto the bed or sofa to sleep next to you; if your pet is slow to climb the stairs, or having trouble getting into the car, or just moving more slowly, these are signs that they’re uncomfortable and that moving around is becoming difficult.  A lot of times, what we think of as ‘slowing down’ in our older pets is actually the result of pain.

-Changes in behavior

Is your kitty getting grumpy in his old age?  Does your dog tend to be less patient or more snappish?  Is your pet hiding and avoiding people?  Just like people, animals get cranky when they don’t feel well.  Before you decide that your pet is just old and cranky, ask your vet if they could be in pain.

-Loss of appetite

Pain takes many forms, and an animal that doesn’t feel well may not want to engage with the world at all.  If they’re in serious discomfort, it can affect their appetite as well as their mobility and behavior.

-Chewing or licking at an area

While there are many reasons an animal may lick or chew at a spot, pain is a possibility.  If your pet is licking or biting at a particular area, and your vet has ruled out other problems like skin infections or parasites, it may well be a sign that that area is painful.

-Changes in body language

We tend to think of body language as a human construct, but animals communicate with their bodies as well.  A pet in pain may sit or lie in a different posture than usual – she may lean more to one side, or keep her tail lowered.  Cats in pain will often ruffle or fluff up their coat, and they can sit with their shoulders hunched and head down.  Also, painful cats will often stop grooming themselves, leading to a flaky or matted coat.

Our pets will tell us when and where they hurt – we just need to learn to listen, and to speak their language.  If you ever have any question about whether your pet is in discomfort, ask your veterinarian – we can help you figure out whether there is any cause for concern, what the causes are, and what can be done to help.

In my last journal post I talked about the challenges that caregivers face, especially when it comes to taking care of themselves as well as the patients in need, and about recognizing our limits as caregivers.  I also promised to talk at more length about some of the options available for support as caregivers face emotionally trying situations, and I’m going to do that now.

Loss of a loved one, no matter what their species, is a painful and challenging situation for everyone, and especially when we’re caring for a loved one in a hospice situation, that grieving process doesn’t necessarily begin at death.  The downside of having extra time to plan and prepare is having time to anticipate and worry.  And while there may be some people out there lucky enough to have no practical limits on their finances or their time, ultimately everyone has emotional limits.  We all feel loss, and fear, and grief, and we all handle these feelings differently and react to them differently – and we all need support at some point in that process.

And added to this is the fact that we each bring our own history to a given situation, coloring our thoughts, actions, and emotional responses.  A pet may be a last connection with a lost family member, making decisions about saying goodbye even more fraught; at the other end of the spectrum, a person who has struggled with a particular disease themselves or watched another loved one face that diagnosis may have a harder time watching a pet face that same challenge.  Ultimately, grief, depression, and anxiety are all very real and important problems that we face, and it’s important to have a support structure in place – and to have the courage and strength to reach out when you need to and make use of it.

Supportive friends and family are a wonderful resource, if you have people in your life who recognize the importance of the human-animal bond and who respect and honor your decisions about your pet’s care.  Reaching out to these people can be a life-saver, whether their support takes the form of a shoulder to cry on, an evening of pet-sitting so that you can have a break from responsibility, or someone to accompany you to appointments and keep you company.

If you’re a religious person, spiritual leaders can also be a valuable source of support, strength, and wisdom.  They may also know of other community resources or support groups.

Pet Loss Support Hotlines can be incredibly helpful.  Even if you have supportive people in your life, it can be helpful to talk to someone who is outside of your situation, trained in support, and is there for the express purpose of helping and listening to you.  Even if your pet hasn’t passed, the volunteers staffing these lines can help if you’re struggling with grief, uncertainty, or questions about what happens next.

Your veterinarian can also be of aid in this process – it’s important to let them know how you’re feeling, so that they can take that into consideration when determining the best treatment plan for your pet.  Our job is to help take care of every living thing in this situation, both people and pets.  If you feel that your veterinarian isn’t able to answer all of your questions, or to give enough time and attention to your emotional needs, it may help to enlist the aid of a hospice practitioner.

Ultimately, if you’re feeling overwhelmed, uncertain, or having trouble coping with your situation, there are also counselors and therapists who specialize in grieving, loss, and bereavement support.  The emotional challenges around death and loss are very real, and can be very challenging, and there is no shame or stigma in needing help in the course of dealing with these things.  And always, always, if you are feeling despair, hopelessness, or overwhelming depression, call a suicide prevention hotline.  You cannot take care of anyone else if you do not take care of yourself first.

For those of you reading this in Massachusetts, I have links to local support options on my ‘Resources‘ page.  If you’re visiting from afar, a search on pet loss support, a call to your veterinarian, state SPCA, or the nearest veterinary school can provide resources nearby.  And, should anyone need it, the National Suicide Prevention Lifeline is 1-800-273-8255.

It’s okay to grieve – but you don’t have to push through it alone.

So far in this journal, I’ve talked extensively about pets and their challenges and how to care for them, for obvious reasons.  But there’s another important facet to pet hospice and caring for elderly pets that is incredibly important, and I think it’s time that I talk about that too.  And that is you.  Every pet that we as family veterinarians ever see has a person attached to it – or people, or entire families.  And when we’re making decisions about how to care for those pets, about their quality of life, and ultimately about the end of those lives, it’s crucial to remember those people and take them into consideration as well.

So let me say it clearly, right here and now.  You matter.

Your hopes, your concerns, your own happiness, your quality of life, and your wants are all important, and they all need to be considered when you’re making decisions about your pet.  While it can seem very noble and loving to put your pet first, whatever you decide to do is going to have to ultimately be carried out by you.  And knowing what resources you have, and what you can and can’t do, is crucial.

We all have our limitations, and they come in many different forms.

-Financial limits – not everyone can afford a few (or several) thousand dollars for kidney transplants, open-heart surgery, or other extensive and complicated treatments.

-Time limits – maybe your lifestyle doesn’t allow for someone to be home to give your pet medication every eight hours, or to take your elderly dog out to go to the bathroom six times a day, or to provide the constant nursing care needed for an animal that can’t stand or walk.

-Emotional limits – if you’ve been through a painful loss before, have upsetting memories or emotional connections to a particular diagnosis or to the process of watching a loved one fail, it may be too painful or stressful to you to be part of this process.

I cannot say this clearly or emphatically enough.  Having limits, or reaching those limits, does not make you a bad person.  It doesn’t make you a quitter, or mean that you’re failing, or giving up, or being unfair to your pet.  Knowing your limits is an important part of decision-making, and you owe it to both your pet and yourself to be aware of both what resources you have to take care of them and what you can’t do.

We all owe our pets love, and we’ve already given it to them.  We do not owe it to them to sacrifice our own health, happiness, or quality of life.  The feelings, health, and mental and emotional well-being matter of human family members *just as much* as the animals’ do.  Treat yourself with the same respect, love, and compassion that you do your pet – and when you honestly feel that you can’t continue, for any reason, it’s okay to say that.

Talk to your veterinary team.  They can help you, and work with you.  They may be able to find a way to work around your restrictions – finding affordable options for care, adjusting medication schedules, or recommending nursing aides that can help with physical care for pets with extreme needs.  Emotional supports are a complicated and detailed enough issue that I’ll discuss them in a separate post.  And ultimately, you may realize that it’s time to let go.  And that’s okay too.

End-of-life decisions are difficult, but they should always take into consideration the needs of every living thing in the picture – both people and pets.  And while we always ask ourselves ‘is my pet ready to go?’ sometimes we forget to ask ‘am I ready to let go?’

As you take care of your beloved pet, take care of yourself as well.  Be fair, be compassionate, and be gentle.  Your well-being matters.

“He’s just old.”

“Well, she’s already 14 years old anyway, so what can we do?”

“What do you expect with a dog his age?”

If there was one idea that I want to counter more than anything else, it would be the idea of “just old.”  One of my favorite professors in vet school liked to say that “age is not a disease,” and that’s a philosophy that I use to drive my practice and my approach to my patients.

Just like people, animals do face changes as they age, and even the best doctor in the world can’t turn back time, or turn your 16-year-old cat into a kitten again.  But age, by itself, doesn’t cause pain or suffering, and there’s no reason for a beloved pet to suffer just because they’re old.

Being old doesn’t cause pain, or illness.  Being old does make our pets more prone to other health problems, but there are also things that we as their caretakers can do to help treat those problems, or minimize their impact on our pet’s lives.

Older animals are very likely to have arthritis or joint disease – but that doesn’t mean they have to live in pain.  There are medications we can use to help control their pain, changes we can make in their environment to make it easer for them to get around (yoga matts are great to avoid slipping; elevated food bowls can make eating easier; low-sided litter boxes can provide easier access for older kitties), additional treatments that can help mitigate pain (did you know that massage, acupuncture, laser therapy, and physical therapy are all available – and helpful – to pets as well as people?).

Older animals may have special nutritional needs.  They may be missing teeth, or may not digest their food as well as a younger pet.  Their sense of smell may not be as strong, making their food seem less appealing.  But with the right diet, your pet can still eat well and enjoy their supper.

As pets age they may also face problems like kidney or liver disease, that can impact their quality of life.  But even these conditions can be helped with supportive care, such as nutrition, hydration, anti-nausea medicine, and dietary supplements.  Even if a family doesn’t want to pursue aggressive or invasive treatment for their pet, there are ways such as these to make them feel better without causing stress or trauma.

Aging pets face special challenges – but with the love of their family and the help of their veterinarian, there’s no reason to put up with discomfort, illness, or diminished quality of life just because he or she is “just old.”

I’ve mentioned laser therapy before here, once or twice, as one of the treatment options that we offer as part of our palliative care and pain control arsenal, but I’ve never had the chance to go into detail about exactly what it is, how it works, or what it’s used for.  So I’m going to take a little time right now to do just that.

Therapeutic laser is, essentially, using a concentrated application of particular wavelengths of light to aid tissue healing and pain control and to decrease inflammation.  The wavelengths of light that this particular laser produces are absorbed by parts of the cell called chromophores, leading to increases in cellular metabolism.

This causes the tissues being treated to produce compounds that provide local pain control, including endorphins.  It also decreases pain by helping inflamed or irritated nerves return to normal function.  In addition, laser treatment improves circulation, decreases the production of inflammatory compounds, and stimulates tissue healing.

What sort of conditions can laser be used to treat?  Just about anything that causes symptoms related to pain, injury, or inflammation.  In a hospice setting, it’s particularly useful as part of a protocol to help control pain from arthritis and acute or chronic joint injuries.  It’s also very helpful for wound treatment, for patients dealing with bed sores, non-healing wounds, or skin infections.

What does laser treatment involve?  Thankfully, for the patient, it’s very simple and pain-free.  Everyone involved – both people and pets – does need to wear eye protection (while the laser we use is safe and painless, it’s always important to protect your eyes whenever working with lasers!); luckily, your vet will be able to provide these for you.  The patient can sit, stand, or lie down in a comfortable position, and your veterinarian will gently move the laser handpiece over the area being treated.  Sometimes, when we’re treating a joint, we may slowly move that join back and forth if it’s not painful to the pet to do so – this is called “passive range of motion exercise.”  Depending on the size of the animal and the condition being treated, a laser session may last anywhere from 5-20 minutes.

For many conditions, especially chronic pain or injuries, several treatments may be required before a response is seen.  At Autumn Care & Crossings, we recommend a starting treatment plan of six sessions over the first 2-3 weeks for most patients, with further treatment based on their individual response.   Some patients heal and can then stop treatment; others move onto a less-frequent maintenance plan as we continue to manage their comfort long-term.

In my opinion, the most important detail about laser treatment, and the thing that makes it most useful for many older patients, is the fact that it has no systemic side effects and is safe to use with other medications.  For animals that may be on multiple medications for other illnesses, or may have conditions that make systemic medications unsafe, laser provides a safe and comfortable way to treat pain that may otherwise go unmanaged.  This also makes it excellent to use in combination with oral pain medications, nutritional supplements, and other pain management techniques.

Ultimately, it’s one of the many tools in our arsenal for helping your pet stay comfortable and happy as they face the challenges of aging!

When I originally came up with the idea of this journal, I thought of it as a place to share my own thoughts, beliefs, and experiences about hospice care – I didn’t want it to become a catalog of links to other people’s words and ideas.  But I came across an article recently that expressed so many of my ideals and beliefs so clearly, and so eloquently, that I need to share it.

http://www.vox.com/2014/10/21/7023257/atul-gawande-taught-me-dying-being-mortal

The article is about a cancer surgeon who took on the challenge of educating himself, his patients, and his colleagues about death, dying, and the choices and experiences around that process.  And I am both moved and heartened by his words.

In particular, the point that resonates most with me is his point that so many people, both medical professionals and patients, perceive the choice between aggressive treatment of disease and palliative care as a choice between fighting and giving up, and the efforts in the hospice field to re-frame this as a choice between two different fights – fighting the disease itself or fighting to lead as good a life as possible for as long as possible.

It’s also important that the medical profession is starting to acknowledge the sobering fact that, ultimately, doctors are neither trained nor paid to discuss end-of-life choices with their patients.  This is true for veterinarians as well as MD’s.  I was lucky to have a mentor who encouraged me to seek out as much training in this area as I could, and to attend a vet school that had an excellent Pet Loss Support program, but many of my colleagues haven’t had those opportunities.  Luckily, it seems like medicine in general is starting to recognize that these skills are incredibly important, and to value them as much as we value surgical skills and diagnostic savvy.

Ultimately, this is just a brilliant and emotionally moving piece, and I hope that you all find it as powerful as I did.

What does hospice and geriatric care look like?

I’ve already talked a little bit about the philosophy of hospice and palliative care, and the challenges of aging, but this is still a very new field in veterinary medicine, and people are still in the process of learning just what can be done to help their pets and themselves.  So I thought I’d take some time to discuss what exactly happens in geriatric care or hospice care for an animal.

As I’ve said, pets do not need to be dying, or critically ill, to benefit from hospice care.  Often, hospice can actually help prolong life – and give an improved quality of life – to a pet that would otherwise not receive treatment for their conditions, or would receive insufficient treatment.

Every case is different, but the basic principles of hospice care remain the same – find out what conditions are impacting the pet’s quality of life, educate the people involved about their options, and take steps to improve the pet’s comfort and the people’s understanding.

For an older dog or cat with arthritis, care is likely to focus on providing comfort and alleviating pain (even pets without terminal diagnoses can benefit from hospice care and evaluation!).  We may recommend therapeutic laser treatment, nutritional supplements such as glucosamine or omega-3 fatty acids, a combination of pain medications (there are multiple different medications out there, many of which work best in combination), changes in the environment such as support harnesses, throw rugs or yoga matts, ramps, or elevated food bowls.  We may also suggest acupuncture, massage, or physical therapy.

For a pet with chronic kidney disease, hospice can focus on nutritional support.  Often these pets are nauseated, and getting them to eat can be a challenge.  Hospice assessment can help find the best diet, provide medications to control nausea and pain, and stimulate their appetite.  For kitties that are difficult to give pills to, medication may be made into flavored treats or provided by injection.  Hospice visits can also help give medications, or teach family members to be more comfortable handling injectable medications themselves.

Cancer is another problem that is sadly common, and can be scary, stressful, and upsetting to people when it happens to the pets they love.  Hospice in those cases depends a lot on the particular diagnosis, but again, can focus heavily on modifying the environment, ensuring nutrition, managing pain, and treating any secondary problems (open sores, loss of mobility, nausea, or the like).

These are just a few of the conditions that hospice can help with.  Most of all, though, hospice visits involve discussion and education.  In every case, we will discuss your pet’s history, their current condition, and your own hopes and concerns.  We will help you understand the course of your pet’s illness and what to expect.  We will teach you how to recognize signs of pain and discomfort in your pet (animals are incredibly talented at hiding their pain!), and how to assess your pet’s quality of life, so that you are better able to advocate for them and care for them.

Our goal is to keep your pet comfortable and happy, and to give you the tools and support you need to make the best possible decisions for them at every stage in their life.