VETERINARY HOSPICE CARE AND HOLISTIC APPROACHES
Dr. Christina Chambreau
ESSEX COMMUNITY COLLEGE
VETERINARY TECHNICIAN PROGRAM
2013
In the last decade, the veterinary profession has begun to address end of life care
for animals. In the 60s many animals died at home. With the increase in cancer and
autoimmune diseases, more owners are being offered only two choices - expensive,
possibly painful interventions or euthanasia. Most veterinarians do not even think
about the hospice approach. Recently, on their site, the American Association of Human
Animal Bond on Hospice says that hospice is a system to provide compassionate end
of life care for animals and supports the caregivers. The focus is on nursing care, not
medical care. It is not about heroic interventions. It is an alternative to euthanasia or
prolonged suffering with no treatment. Pain management and relief of symptoms are
the main focus. Home nursing care is best provided by veterinary technicians. AVMA
and other conventional groups are presenting some hospice information at least annually.
Much education of veterinary professionals is still needed. Dr. Bittel says,
"Currently, the majority of our animal family members are euthanized." Dr. Robin
Downing says, "In 23 years of practice…the number of animals who die a natural death
is few and far between. We have an obligation to let them [animals in distress] leave
while they still know who they are and who their family is." For most veterinarians this
leads to encouraging euthanasia. Holistically trained veterinarians know they can use
a wide variety of approaches, including conventional drugs to allow animals to live
out their full life with awareness and usually die on their own.
Richard Timmon, DVM says: "Hospice care as an alternative for managing a
companion animal at the end of its life has struggled to insert itself into the protocols of
companion animal medicine. Increasingly sophisticated technology has promoted a
hospital-centered practice that does not have the flexibility to support the home care
necessary for effective pet hospice. Veterinarians have been quick to recommend
euthanasia when death is imminent, usually based on the desire to avoid suffering.
However, new options for pain management should give pause to this reasoning…. There
has not yet been research that confirms that pet hospice helps family members deal with
their grief more appropriately than hospital euthanasia. But Veterinary Family
Practitioners who offer hospice services find that increasing number of clients will
gratefully choose this approach."
This is a huge area of opportunity for CVTs, as you will see. If you develop some
holistic skills you will be even more in demand as home hospice care provider. You may
even decide to start a hospice care business of your own.
Most of the following guidelines and comments have come from the resources
listed at the end of this article, and are given without citing each one as there is a lot of
overlap. If you want my notes from collecting this information, please email me at
HealThyAnimals@aol.com.
I. Informing owners of another choice.
A. Heavy western medical intervention.
B. Euthanasia
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C. Hospice can be a wonderful, caring option for terminally ill pets. However, pet
owners should keep in mind that pet hospice care may not be for everyone.
Some owners may not be ready or able to take on the often painful, emotional,
and time-consuming work of the day-to-day care for a sick pet. Hospice may
not be the right decision for owners who live alone, have a heavy work
schedule, or are not in good health and cannot afford professionals to work in
the home with them. Owners should carefully consider whether they have the
resources necessary to care for their pet at home and talk to their veterinarian
about what is right for them. Hospice allows pets to pass away feeling safe
and loved and gives pet owners a chance to say good-bye at their own pace. In
the words of Dr. Clough, -Death isn’t losing the game. Death is unavoidable;
it’s a part of life. If you make death a safe, loving, comfortable
experience, then you’ve won the game.
D. Holistic treatment which can be curative, or can really be hospice care as it
eases the different symptoms.
II. Providing quality of life evaluations
In 2001, (http://www.pet-loss.net/quality.shtml), Moira Allen gives a description
of quality of life indicators and reminds us these are to be used throughout life, not only
at the end of life. They are mobility, appetite, ability to eat, discomfort, pain,
respiration, mental capacity, incontinence, happiness and response to treatment.
These will be more useful at the point of deciding if it is time for euthanasia.
To this I would add the early warning signs of illness
(www.ChristinaChambreau.com) and in week I handout. These are actually more
important because they are much more subtle indicators that a change needs to be made
in the treatments offered.
Nikki Hospice defines a hospice patient as meeting the following: a) it has
been given six months or less to live; b) it has a limited prognosis and a progressive
disease with quality of life issues to consider; c) it has evidence of clinical decline such
as multiple visits to the veterinarian, multiple or extended hospitalizations, a decline in
functional status evidenced in three out of four ADLs (Activities of Daily Living - selfgrooming, feeding, locating, ability to control urine or stool, righting, or ability to ambulate),
impaired nutritional status, fluid retention or dehydration, weight loss or anemia, is
symptomatic of pain, has dyspnea at rest, is unable to vocalize or vocalizes abnormally, or
has lost the ability to smile or greet the caregiver or other family members. Symptoms
which should always be defined, assessed, interpreted for the caregiver, and ultimately
treated are dyspnea, coughing, sneezing, nausea, vomiting, constipation, seizures, fever,
hemorrhages, agitation, restlessness, avoidance, vocalizing, pain and urinary retention,
among others.
Avoidance of food is not a mandate for euthanasia. Dr. Ella Bittel says, "The
animal may refuse food. How often have I heard that sentence “I KNOW it is time (to
euthanize, but we skip that word, don’t we), when my animal stops eating.” Fasting is a
natural preparation inside the transition process. From the human field we know that the
dying just don’t feel hungry anymore. It’s the wise way of nature—the body knows it can no
longer properly digest, plus it won’t be using that fuel provided by nutrition anymore. The
bottom line is this: the physical condition of an animal isn’t all decisive, but rather its
internal state.
Does the animal still want to live? Animals are blessed in a way. They don’t
compare their current condition to the strength and vitality that was available to them in the
past. They don’t look into this gloomy future of never again being able to run around as they
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used to. They tend to go with the flow of things without questioning them. In fact, they even
deal with pain often quite casually. My neighbor’s dog still chases trucks with the same
vigor, whether or not his one knee gives him pain to the point that he can’t put weight on it
anymore. Even at the end of an animal’s life, being in pain does not automatically
equate to no longer wanting to live.
Another team member in making these decisions could be an animal communicator,
like Jeri Ryan. She says, "The ups and downs of this final stage are not surprising. Death is
final. There is bound to be ambivalence about leaving life. It would be a tragedy to send an
animal to its death before it is ready….As an animal communicator, I inform the animal
of what is going on in its body – and of the prognosis – in very gentle caring terms and
tone. I relate the options, and I make sure it can make an informed choice about its life
or death by describing the options and potential outcomes, and by describing
euthanasia and its purpose. I make certain the pet knows that the life or death decision
is entirely its choice, and that it is neither considered a burden nor expected to stay for
its person….There is another reason when quality of life slips for the animal. This occurs
when boredom becomes depression and makes a being want to leave life. Most often the
animal requests that life remain as normal as possible, so it becomes incumbent upon us to
do our best to provide as high a quality of life as possible to prevent depression….In such
final life/death decisions, animals must have the final say. They may express it vocally or
through body language or both. In the event of any uncertainty, telepathic communication is
available. When hospice is in effect, animals have a chance to work through the
ambivalence and leave, without assistance, on their own schedule."
III. Working out a treatment plan with the caregivers
This is a great role for the CVT, guided by the veterinarian.
A. Conventional concerns and treatments.
1. A common end of life symptom is pain. The conventional approach is as follows.
Pain may be opiate dependent and therefore atypical (in bones, nerves, or muscles) or
require an analgesic (non-opioid, weak opioid or strong opioid). Veterinarians are
encouraged to begin administering these kinds of analgesics slowly, increasing them at a
moderate rate so as to avoid side effects (which should always be anticipated and fully
explained to the caregiver), to constantly evaluate the compounds being used and their
efficacy in reaching the desired effect. I will later address the holistic approaches for pain
that have few side effects. If they work, you continue them. If they do not help, you try
another one.
2. Wounds and hemorrhages need to be addressed and the owner needs guidance
as to how to treat these at home. Again there are many holistic treatments.
3. Urinary incontinence that is non responsive to drugs needs to be managed with
pads, rolling, cleaning, trimming of excess hair. Holistically we can often stop it completely.
BrightHaven has found that some cats do better with a littler bow with a 1" lip, lined with
soft towels/rags. Dogs may need more frequent walks. Diapering can be needed. The normal
urinary incontinence drugs may help (it is best to stay away from the one with
anticholinergic effects). Litter boxes or pee pads may, of course, have to be placed in the
rooms the animal frequents.
4. Bowel issues also can respond to specific medications as well as nursing care.
Bowel incontinence has little to help it in conventional medicine, but can be helped a lot
with holistic approaches.
5. Appetite issues can be addressed with drugs such as Valium, by offering different
foods, or with holistic alternatives. Appetite may be low because of lack of dietary
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tryptophan leading to lower production of serotonin that is needed for melatonin. This could
account for some of the sleep problems.
6. Sleep problems, therefore, need good dietary tryptophan, stimulation during the
day and very soft beds (or whatever the animal needs) so the animals (often seen in cats)
will get to a deep REM sleep. When cats do waken, it may be better to ignore them and not
comfort them since it could start a behavior problem. I would say that with holistic options,
you could comfort the cat and still get good night's sleep - for most cats.
7. Brain problems like senility lead to cognitive disorders that make the animals
feel out of sorts. Changes in routine are challenging to them. It could cause pacing,
vocalizing, fears, anxiety and acting out by chewing furniture or puppy type behaviors.
There are few conventional drugs to address these issues, so holistic modalities are needed
here, along with animal communicators.
8. Aging affects the senses, so they may be more sensitive to stimuli and need
"hiding places/dens". Be sure to give plenty of contact and do not let them just hide away.
Some hearing loss may be selective!!! If they can hear a bit, you want to clap or yell before
startling them with touch. They may want gentler touching, stinkier foods, etc. As a CVT
you will have enough experience with ill animals so you can give a lot of good suggestions.
9. Company, touching, and many of the holistic modalities are critical to keep the
animal enjoying life to the fullest. Try different toys.
B. Holistic options for the conditions listed above.
First remember that if you are treating with holistic perspectives you are already
doing hospice care if the animal is old or very ill. The holistic perspective treats the whole
animal and usually successfully treated animals die an easy death taking only a few weeks
or less, even if they get cancer or other serious metabolic diseases.
Second, every condition above can be treated by any of the holistic modalities that
were covered in your first class notes.
Third, a few specifics: (know at least one holistic treatment for each category.)
1. Pain. Western herbs: White willow bark, passion flower, yarrow, cayenne, ginger.
Reiki. HTA and TTouch both have specific pain points. Massage. Rescue Remedy or any of
the Emergency Essences from different companies. Acupuncture. Homeopathic: Arnica,
Hypericum, Belladonna and many others for specific types of pain.
2. Bleeding will often stop miraculously with a Chinese herb, Yunan Pio, given
orally and/or topically. Homeopathic Arnica or Calendula can stop bleeding. Western herbs
- cayenne pepper powder, plantain, Yarrow.
3. Incontinence - urinary. This usually needs professional treatment with
acupuncture or homeopathy. Western herbs can help - Oatstraw, plantain, corn silk, nettle
root and horsetail.
4. Bowel - This usually needs professional treatment with acupuncture or
homeopathy.
5. Appetite - There are acupressure points you can teach owners to stimulate
appetite. Doing Reiki on the food will help. Many of the homeopathic remedies stimulate
the appetite. Western herbs - Boswellia, caraway, coriander, fennel, gentian, yucca.
6. Sleep - melatonin. Passion flower. Rescue remedy. Any of he calming essences.
Massage, HTA and TTouch, especially the anxiety wrap.
7. Senility - This usually needs professional treatment with acupuncture or
homeopathy.
IV. Homeopathy in Hospice
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A. Cases
The following are a few cases who may have been considered hospice who went
on to live a much longer life than expected, with the use of homeopathy that will
demonstrate what we just covered.
From De Buchaeler's book, What to expect from homeopathy, come two great
cases. "An "old gun dog" appeared a few months prior at a farm, then developed severe
heart failure. Sudden lack of energy. Can hardly walk. The heart was very enlarged heart
and the EKG demonstrated severe arrhythmias. He gives the impression, sometimes, that
death is near. Dignified, Haughty. Growls/coward. Sings in front of radio, watches TV
and pushes on the remote control. At 6AM - wakes them, at noon he goes to the table and
calls them. Arrogant. Punishes himself before I can punish him. He wants to be perfect.
Crusty growths on eyelids. Clean teeth. Never drinks water. Will not walk in water.
Craves sugar. Sleeps on his back. Only will eat his food burning hot. We have two
aspects to this case that are striking - the sudden onset of heart disease with specific
physical symptoms and the many unusual mental and emotional symptoms. Some
veterinarians would recommend euthanasia at this point because of his age and unknown
history. The dog would be considered terminal within 4-6 months. One approach is to
start with drugs to treat the enlarged heart. The treatment plan would be continuous drug
therapy with frequent re-evaluations of the arrhythmia and size and function of heart
using EKGs, Ultra sound, and/or X-rays. My experience is that the dog would decline in
many ways, especially emotionally. Another approach is to treat this dog with
homeopathy. The results with homeopathy can be a complete cure with no more
treatment needed, or a continuous treatment of the symptoms (like with drugs) including
the mental symptoms, so the dog will usually feel much better emotionally and have
more energy to participate in the household. There may be occasional veterinary consults
or more frequent ones if the "best" remedy is not found. Usually animals who are
successfully treated (few doses or continuing to find different remedies) will die quickly,
in their sleep or at home. Dr. Rouchoase gave homeopathic Aurum 9C every two days.
After two doses, the owner reported a complete change. "…no more capriciousness, no
more fear of water and excellent physical condition…. One year later he is still fine. In
the case of severe heart failure this is quite a remarkable result."
“Oldie is 13 and has been coughing for 5 days. He has recently aged with many
senile behaviors - refusing to stay on his own; destructive when alone; hides when afraid;
afraid to stay outside; does not sleep well; disobeys all the time; ravenous, especially for
sweets; thirstless. These new behaviors and his age may put him into the hospice
category. As a conventional veterinarian, I would see dogs like this who had to be
euthanized because the owners could no longer sleep, or be able to tolerate his new and
destructive behaviors, nor feel that it was fair to him to "suffer" the feelings that seem to
lead to these behaviors. I would have been frustrated because I knew the dog was not
ready to leave this planet, yet there were no temporary guardians available to work with
the new symptoms appearing in "Oldie". The owners, and maybe myself, would
rationalize that he had had a long life, so it was ok to euthanize. Other guardians would
spend hours, maybe even to their detriment, to care for a dog who had slipped into this
state, using drugs to help the behaviors. Dr. Brunson was able to find a homeopathic
remedy that moved this dog out of the hospice category. One dose of Lycopodium 30c
resolved the cough in a few hours and he was not seen for 18 months. His behaviors had
also resolved, so there was no need for further treatment. (he is now nearing 15 and will
be staying with the parents for the holidays and they want to prevent the coughing that
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often occurs there, so a Lycopodium LM6 is given and there was no coughing. 5 months
later the owners report that Oldie is losing his hearing (often one of the symptoms that
needs to be managed in hospice situations) and is still startled with noises. He is back to
eating a lot and staying thin; has a wart on one eyelid; is very bothered by the heat; is
very thirsty. Sulphur 30K is given once and while he feels better overall, his cough comes
and goes. 8 months later the cough and other symptoms have become worse and the
Sulphur is repeated to no deep improvement and a month later he is even worse with
senile symptoms and the cough. Phosphorus 30c is given and he becomes much worse in
a few days. Psorinum 12c is given with great improvements, so is given at a 30c eight
days later. One year later (17 now) the cough returns, Psorinum 30c does not help, but
LM6 does. The deafness continues to worsen, but all other symptoms, even the
behavioral ones, have resolved. He dies 6 months later in his sleep."
Dr. Jensen, a homeopathic veterinarian, comments, "Countless cats have been
euthanized in their teens (and even earlier) after that dreaded-and-all-too-common
diagnosis of chronic renal failure."
Dr. Chambreau had a cat present at age 16 because two veterinarians had
recommended euthanasia because the symptoms of renal disease were severe - vomiting,
weight loss, inappetence, poor hair coat, lethargy and a behavior that did not allow subcutaneous fluid administration (had to be deeply tranquilized to draw blood). The cat,
when I took the case, was very fearful, very chilly, very fastidious and even liked to drink
warm tea, so I prescribed Arsenicum album 6c daily. Within a month the cat had returned
to normal and went on, with some repetition of the Arsenicum album, to live to 22. She
became ill and no remedy seemed to help her and she died within a week.
Dr. Ed Shaeffer was called out to give a death certificate on a downer cow.
Instead he gave 10M Phos and she lived 8 more years and was best milk producer of the
herd.
B. General homeopathic information
Dr. Pitcairn says that most books well grounded in the homeopathic and holistic
perspectives do not make a big distinction about hospice care, as we are always
committed to finding the best treatment for this animal at a specific time. Usually this
means trying to cure, sometimes it means recognizing that the animal is not responding in
a curative direction. In that case, which could be a hospice situation or could be at any
stage of life, we look for treatments/remedies that improve the quality of life as much as
possible. This is what I expressed earlier.
Gail Pope, of Brighthaven (12), says that in the last few years they rarely have to
give any special remedies for the death process. Animals just become quieter, more
ethereal, more relaxed, then die within a few days. If any remedies are given it would be
the "constitutional" or "chronic" remedy that has helped keep them healthy so far.
Sue Armstrong (2.) points out that most animals who are treated homeopathically
do well for a period of time (weeks to years), then have a short crisis andam die quickly.
"Despite functional organ depletion over time, the animal is often able to maintain a good
vitality and state of wellness right up to the day and act of death." This is why "hospice"
homeopathy is often just good homeopathy.
RESOURCES FOR HOSPICE CARE
http://aah-abv.org/Net/Home/Hospice.aspx
American Association of Human Animal Bond on Hospice
http://www.avma.org/issues/policy/hospice_care.asp
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The AVMA hospice guidelines.
http://www.avma.org/onlnews/javma/apr09/090415o.asp
JAVMA article.
www.iaahpc.org
International Association for Animal Hospice and Palliative Care,
http://www.healthypet.com/PetCare/PetCareArticle.aspx?art_key=a6d7c944-88bd-4c44-8cea607db329cd8f
American Animal Hospital Ass Guidelines
http://www.veterinarypracticenews.com/vet-practice-news-columns/bond-beyond/reflections-onthe-international-symposium-on-veterinary-hospice-care.aspx Article
www.pethospice.org
Nikki Hospice Foundation for Pets
Drs. Jeri Ryan and Kathryn Marocchino are the two phenomenal women who made the First and
Second International Symposia on Veterinary Hospice Care a reality. I spoke at the second one.
CDs available on conference for $35 at http://www.pethospice.org/FISVHC%20CDs.htm
.
http://www.spiritsintransition.org/
Ellen Bittel, DVM
www.BrightHaven.org
Holistic care of older animals. 35 year old cat!! Two great end of life booklets.
http://www.icraeastbay.org/LL_08_FA.pdf
This issue of the Latham Letter was entirely focused on hospice care for animals.
http://www.specialneedspets.org/hospice.htm
Resources
http://www.angelsgate.org/
400 animals on a farm. A lot are in hospice. Susan Marino is a passionate advocate.
http://housewithaheart.com/index.shtml is in Maryland - Gaithersburg.
http://www.onehearthealingcenter.com/
A page of 20 or more essential oils that could be useful in hospice.
www.2ndchance4pets.org
Helps people treat their animals
http://www.caringforcreatures.com
Caring for Creatures Animal Sanctuary, Fluvanna County Virginia
http://www.peacefulpassings.org/resources.htm
Pet Loss Support Telephone Hotline - Virginia
(540) 231-8038 Tuesday and Thursday 6-9 pm Eastern Time--staffed by Virginia-Maryland
Regional Veterinary School Students
Cornell School of Veterinary Medicine: http://www.vet.cornell.edu/public/petloss/other.htm
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VCU Center for Human-Animal Interaction (804) 827-7297
Blessing the Bridge / Rita Reynolds http://www.blessingthebridge.com/about.htm
A Peaceful Journey for Animals – Animal Hospice
http://www.apeacefuljourneyforanimals.com/hospice.htm
Cheryl Falkenberry - Behavior Counselor (434) 591-6113 or email to
cheryl@centerhillschool.com http://www.centerhillschool.com
Geriatric Animals: Behavior Problems in Cats and Dogs
http://www.cavm.net/Files/Geriatric.htm
Four Flags Over Aspen: ffoa@fourflags.com 1-800-222-9263
Pet’s Edge: http://www.PetEdge.com 1-800-738-3343
Care-A-Lot Pet Supply: http://www.carealotpets.com 1-800-343-7680
J-B Wholesale: http://www.jbpet.com 1-800-526-0388
Ashes to Ashes, Jewelry, Urns & Keepsakes http://www.ashestoashes.com
Getting in Touch with Your Dog by Linda Tellington Jones
Getting in Touch with Your Cat by Linda Tellington Jones
Blessing the Bridge by Rita Reynolds
Rainbows and Bridges: An Animal Companion Memorial Kit by Linda Anderson
As Time Goes By - Gail Pope
Into the Light - Gail Pope
Email me at HealthyAnimals@aol.com to get a copy of my talk:
HOMEOPATHY AND NUTRITIONAL APPROACHES FOR VETERINARY HOSPICE CARE
Presented at the 2nd International Symposium on Veterinary Hospice Care, 2009 if you are
interested in pursuing this. Several local veterinarians have said this is the main area for growth.
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