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  • Dr. Rob Silver, an integrative veterinarian who practices in Colorado, has developed a questionnaire to assess quality of life in geriatric pets
  • Three of the most important measures of an older pet’s quality of life are play behavior, symptoms of clinical disease and general happiness as perceived by the pet parent
  • The results of Dr. Silver’s survey are designed to help vets and pet parents offer specific remedies and therapies to improve or maintain the animal’s quality of life
  • A natural remedy Dr. Silver has researched extensively and written about is cannabis for pets
 

Does Your Elderly Pet Have a Good Quality of Life?

March 05, 2017 | 31,517 views
| Available in EspañolDisponible en Español

By Dr. Becker

Today I'm interviewing Dr. Rob Silver, who just finished giving a four-hour lecture series here at the American Holistic Veterinary Medical Association (AHVMA) conference on the topic of geriatric pets. In particular, I invited Dr. Silver to talk with us today about assessing quality of life in geriatric animals.

Quality of life is what makes life worth living. Once it begins to diminish in our pets, since they can't talk to us, it can be very difficult to determine whether or not they still have a good quality of life. It's difficult to know if we have more time with them, or if it's time to let them go.

Dr. Silver explains that in recent years the veterinary community has developed questionnaires to assess the quality of life in sick animals, for example, pets with kidney failure, spinal cord trauma, heart disease, cancer and so forth. But no similar questionnaire existed for geriatric patients, so he created one.

He wanted to give veterinarians an objective tool to use when examining an older animal to help assess the quality of the animal's life. Are we doing enough for this dog or cat? Are we doing too much? It's a tool to help both vets and pet parents make good decisions based on a set of objective measures.

"If we're talking about euthanasia and saying goodbye," explains Dr. Silver, "it's good to have some objective basis to make that decision. This way, it's not on the vet.

This is the hardest time in a veterinarian's relationship with a client. The two most important times, I think, are when the puppy comes in for the first time and when he's 15 years old and he's leaving.

That's really when your relationship with a pet parent is most important. You can make or break that relationship in those moments. You need to be able to give good objective advice to the client. That's why I developed the quality of life questionnaire."

The 3 Most Important Factors in Assessing Your Pet's Quality of Life

Studies show that when it comes to a pet's quality of life, there are three important factors. The first is play behavior. When an animal stops playing, it's an indication he's not in a happy state.

"For example," explains Dr. Silver "I've got a 19-year-old cat. Just before I left to come to this conference, I was trying to get all my little cables together for my computer and he's there batting at the cables and I'm thinking, 'Cool. This guy's got play behavior.'

After all, he's 19. Even though he looks kind of thin and walks around rickety, he's got play behavior, which is good."

The second important measure is whether an animal is showing signs of clinical disease. For example, if the pet has arthritis, is she limping badly or are the signs subtler? If she has chronic kidney disease, is she still able to control where and when she urinates?

Is she drinking all the time or losing weight uncontrollably? These are visible markers clients can use to assess their pets themselves and also share with their veterinarians. The sharing of information between client and vet is crucial, because as vets we only see the patient for a short time in the exam room.

We get just a quick snapshot of the animal, whereas the pet parent has a much more complete picture that can often be very different from what we're able to see during an exam.

The third factor in assessing quality of life is the owner's perception of their pet's happiness. Owners are able to make this assessment because they've shared life with their pet for many years. According to Dr. Silver, pet parents tend to be very accurate in evaluating whether their animal companion is happy.

Parents of Geriatric Pets Can Develop Caregiver Fatigue

This last point is interesting to me, because I've had so many clients with a geriatric pet tell me, "I don't know for sure if he's happy. I think he is, but I don't know for sure." There seems to be a lot of anxiety around knowing for sure.

Dr. Silver calls this anxiety "caregiver worry," and it's a big deal for pet parents. That's why one of the first questions on the survey he developed is for the pet's owner. "How was the pet six months ago?" followed by "How is the pet today?"

Then it's the vet's turn to answer a set of questions about what he or she found during the pet's physical exam six months ago versus what was found today.

There are also questions for pet parents designed to assess what we call "caregiver fatigue." For example, if a person has a geriatric pet at home who can no longer poop on his own and the owner has to stimulate him multiple times a day to help him eliminate, it can get really exhausting.

When pet parents have caregiver fatigue, their ability to understand things and make objective decisions is diminished. The level of fatigue is factored into the way in which the pet owners answers questions on the survey.

Helping Geriatric Pets Maintain a Good Quality of Life

Once the veterinarian has a good idea of how their geriatric patient is doing, he or she can offer targeted options for maintaining the animal's quality of life. When it comes to managing pain and inflammation, most conventional vets will give Rimadyl and perhaps some tramadol.

When those drugs no longer work, they may go to a fentanyl patch. When the fentanyl no longer works, they're out of options. Dr. Silver takes a very different approach not just to pain management, but the overall management of geriatric pets.

As he explains: "I think there are lots of ways to enhance well-being, to help an animal feel better without the use of strong pharmaceuticals. But at the same time, I have to say I'm not against the use of strong pharmaceuticals because they're very important."

I'm not against those drugs either, depending on the circumstances. In fact, I recently did a webinar on winding down and helping pets die well that many of you watching today may have attended. In the webinar I mentioned that because I'm a holistic veterinarian, some of my clients are appalled when I recommend a fentanyl patch for a pet that is in the process of dying.

I've had clients say, "I can't believe you, of all people, are recommending a fentanyl patch at this point," to which I reply, "I'll recommend whatever it takes to keep this pet pain-free at this point."

Like Dr. Silver, I always try to start with natural remedies and postpone for as long as possible the use of potentially toxic drugs. Unfortunately, many conventional veterinarians do the reverse because they have so few tools in their toolbox. They start with drugs, and when those no longer work, they may or may not consider safer, more natural options.

Cannabis for Pets

Dr. Silver practices in Colorado, so he's very interested in hearing from clients who are using some form of cannabis with their pets, typically either hemp or medical marijuana. Many of them are reporting very good results with their pet's pain management (including cancer pain) anxiety, restlessness, appetite and more.

"I have been doing intensive study and research and then lecturing to both veterinarians and pet owners about the benefits of cannabis," he says, "understanding that we still have a number of legal hurdles to go over before it's no longer such a gray area and easier to do."

According to Dr. Silver, the research into cannabis is booming but there are restrictions due to the current regulatory environment. So as veterinarians we have both a learning curve about cannabis to overcome and a regulatory situation as well. The regulatory hurdle is a more serious impediment than lack of research. "We have a ton of research already," says Dr. Silver.

"We just need more. But getting the materials, getting the tetrahydrocannabinol (THC) or the cannabidiol (CBD) is difficult because it has to go through the Drug Enforcement Administration (DEA), which usually takes two or three years."

It takes so long for a researcher to get a license to get the materials, that it's hampering research efforts.

Research Into Cannabis for Pets Faces Many Hurdles

I asked Dr. Silver if he knows of any research projects specifically focused on veterinary use of CBD and hemp for pets. "I'm aware of research that's NOT going on," he replied.

"For instance," he continued, "a good friend and colleague, [Dr.] Dawn Boothe, is a professor of clinical pharmacology at Auburn University. Dawn has an interest in anticonvulsant pharmacology. Ever since information came out about CBD and seizures, she's been chomping at the bit.

She's applied twice to the Morris Animal Foundation [MAF] for grants to study the pharmacokinetics of CBD and to start applying it with some patients, both equine and canine. Both of her grant proposals have been turned down. The DEA is now telling her she has to apply for a Schedule 1 license and can only use CBD supplied by the DEA. By the time she jumps through those hoops, it's going to take a substantial amount of time to get her research of the ground."

Most veterinarians in Colorado and elsewhere are very reluctant to give cannabis advice to clients with pets who might benefit from it, according to Dr. Silver. Vets are worried about liability issues and potentially losing their license to practice veterinary medicine. So pet owners are choosing to go it alone.

"This is one reason I wrote my book, 'Medical Marijuana & Your Pet,'" says Dr. Silver, "because I wanted to give guidance to pet parents so that if they are interested, they can introduce it and understand what it does in a way that's safe and effective."

Dr. Silver's book offers information pet parents can't get anywhere else. Most vets simply don't know enough about the subject, nor do they want to take a legal risk. So the book is very much appreciated.

"It's important to know that in studies done in the 1970s," says Dr. Silver, "researchers found that dogs are more sensitive to the adverse effects of THC (tetrahydrocannabinol) than any other species. This is the reason THC is such a bad boy with dogs, but not cats, and why we have to introduce it gradually. Otherwise, we're in trouble."

Hemp as a Substitute for Marijuana

Since THC can be a really bad idea for dogs, I asked Dr. Silver about hemp. He has actually developed a product that contains hemp and the cannabinoids found in hemp.

He explained that as of 2014, states are allowed to pass laws to grow hemp, and each state's department of agriculture is in charge of regulating it. Currently there are about 30 states growing hemp. There is also proposed legislation called the Hemp Bill of 2016, which Dr. Silver expects to become law because hemp has such economic value to the U.S.

Hemp is a very versatile plant. You can make paper with hemp, fabric, rope and even building materials. "In fact," says Dr. Silver, "the first American flag was made out of hemp. The revolutionary war soldiers' uniforms were made out of hemp. It's a great plant."

Dr. Silver says the CBD in hemp can actually work better than THC in many instances. He knows of several cases in which hemp is performing as well as anything he would have expected from THC. "I've got some oncologists using it and finding it helps to improve appetite in patients receiving chemotherapy," he says.

Up until the experience with the oncologists, it was thought that only THC could stimulate appetite. But as it turns out, CBD does as well. It could be that it's the pain relief properties of CBD that help pets feel hungrier, but the end result is the same — their appetites improve. Since both hemp and marijuana have CBD, I asked Dr. Silver how to differentiate between the two.

"That's where the whole gray area comes in with regulatory issues," he answered. "The DEA contends that you can't tell the difference between hemp and marijuana and, in some cases, you really can't.

The only way to tell the difference is to analyze it for its THC content. The definition of hemp is it has less than 0.3 percent of THC on a dry matter basis at harvest time. That has to be checked by each state's department of agriculture. If the crop has more, they destroy the crop, or if it has a lot more, they arrest the farmer."

Does Hemp Work as Well as Marijuana?

There are people who claim hemp doesn't work as well as marijuana. However, Dr. Silver believes the CBD in hemp works well with animals, even at very low doses.

"The bodies of animals have a system related to the nervous system that produces molecules that are just like THC," he explains. "In fact, this offshoot of the nervous system is so primitive that it goes back to the jellyfish. The jellyfish had the first primitive nervous system.

This 'Endocannabinoid System' is an important part of the nervous system that we never knew existed. The only way we learned that it existed was when they were able to discover the shape of THC in the mid-1960s in Israel. They then started looking for a receptor in the body. The receptor is more like a lock and a key.

The THC is like the key and the receptor is like the lock. When the key hits the lock, in other words when the THC hits the body's receptor, it turns the lock and then something happens within the cell. Maybe it produces an anti-inflammatory molecule or it signals another cell."

That's kind of how it works. You don't need a lot of the molecules to turn those locks because really all it's doing is it's just turning the switch and the body's doing the rest."

Conditions That Respond Well to CBD

According to Dr. Silver, the most successful applications so far for CBD include anxiety, and mild to moderate pain. In addition, he's also seeing some reduction in tumor sizes with CBD alone. For pets with seizures, he's seeing CBD helping pets with simple seizures, either not on medication or only on one or two anti-convulsants.

Pets with more complicated, refractory seizures, that are on several anti-convulsants, and are still having breakthrough seizures, don't respond as well to the CBD for their epilepsy. "We still need to figure out where to use it and where not to," says Dr. Silver. The challenge with seizures could be that there are so many different causes of the disorder.

All in all, I think CBD could shape up to be a very exciting, all-natural substance that can dramatically improve the well-being of geriatric animals, and other animals as well.

"That was my point with this lecture," explains Dr. Silver. "First, I wanted to talk about how we can establish quality of life. Then I wanted to move into how we can impact quality of life with a good diet, and supplements like fish oil, antioxidants, tonic herbs like astragalus or ginseng, ginkgo for memory and cannabis."

I think cannabis has a very legitimate place in helping geriatric pets improve their quality of life and especially with the hospice patient in hospice care. I think cannabis has its highest calling there."

Medicinal Use of Cannabis Is Gaining Broad Acceptance

I really appreciate Dr. Silver's insights on the evolution of cannabis in the treatment of veterinary patients. He's been on the front lines of this revolution. I'm definitely seeing a growing acceptance of it across-the-board, even with my own mom and dad, who are very conservative, straitlaced people.

They're in their mid-70s and are realizing they judged the entire topic very harshly. They're benefitting from the capsules and pills and ointments and tinctures they were once very close-minded about.

"Once people realize it's not about getting high, it's about getting well," says Dr. Silver, "they become more open-minded. The strategy for use of medical marijuana for humans and animals involves minimizing the psychoactive properties. You can do that with CBD because CBD reduces psychoactivity.

We are definitely seeing a shift in attitudes. We're seeing people like your parents who had been resistant to it, who are seeing their friends benefit from it, who have their own geriatric ailments that might benefit. They try it, and lo and behold! It's really an amazing plant as far as what it can do and how far it reaches."

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