End of Life Care
One of the most heartbreaking duties that we as veterinarians perform is helping our terminally ill or suffering patients to die painlessly and with dignity. There is a growing need for palliative and hospice care for our pets and many veterinarians are starting to offer those services.
When we talk about palliative care we must assume that the pet has been diagnosed with a terminal illness but there is still enough quality of life that the owners pursue this path. In our modern veterinary medicine we might consider death as a failure, but in many cultures around the world, death is seen in more benign and inevitable terms.
When the pets are in the later stages of declining there are biological changes to the blood supply and gut which cause picky appetite, and gi disturbances. In reality dehydration and anorexia increase endorphin release in the brain which might be a biological way to provide comfort at the time of death. However, if you only wait for your pet to stop eating, you might ignore the other signs of pain and suffering so always have a veterinarian evaluate for that. Pain can definitely cause restlessness, behavior changes and physical inability to eat. The use of an integrative approach to pain control usually includes pharmaceuticals, acupuncture, herbals and supplements, Assisi loops, laser, and massages.
The Traditional Chinese Veterinary Medicine perspective on the dying process can help understand this process because it attributes some of the declining symptoms to specific patterns affecting the organs. We all come with a certain Jing, or the energetic ability to repair our cells. This Jing is stored in the Kidneys which means the only natural pet death is that of kidney failure. The behavior and anxiety issues that our dying pets experience could be explained because as the Heart meridian weakens, this is the seat of Shen or spirit, the Shen is trying to leave the body. Anorexia and muscle wasting are caused by Spleen Qi (energy) deficiency since in TCVM the Spleen meridian controls the muscles and is responsible for food absorption. The light sensitivity, pain, seizures, and bouts of aggression could be related to the Liver meridian Qi stagnation. Acupuncture for palliative care involves points in those energy pathways.
When it comes to the final goodbye, the setting is important, we want a peaceful transition so there should be a peaceful, quiet atmosphere or maybe relaxation music could be playing in the background. The pet owners need to be aware that there are possible indignities of diarrhea, urinary incontinence, dyspneic breathing, seizures/convulsion, and vocalizations in the dying process. The veterinarian does all he/she can to inform the pet owners of all these possibilities in order to avoid fear or regret after witnessing one of those happening. If you ever had such an experience, rest assured that the dying process is painless but there is a terminal delirium caused by toxin buildup but that could result in those less than desirable experiences. Hospice care for pets can help our pets live their best lives until providing euthanasia is deemed necessary.