By Dr. Becker
Dr. Alice Villalobos, a pioneer in the field of pet cancer care and founder of Pawspice, a pet hospice service, believes the end of a pet's life should be recognized as a distinct stage.
Currently, veterinarians are taught to deal only with the four prior stages of life, which are:
- Puppy or kitten stage
- Adult stage
- Senior stage
- Geriatric stage
"We were not educated to focus our professional attention and develop the skills and expertise for the very important and inevitable End of Life Stage," says Dr. Villalobos.
She believes vets need to offer more End of Life (EoL) services because the bond pet owners and their companions share demands a better level of care than is widely available when a beloved pet is at the end of his life.
Dr. Villalobos makes the point that the End of Life Stage would be the only life stage that can occur during other stages.
End of Life Services Offer Options for Pet Owners
Veterinary students learn how to euthanize an animal at the end of its life, but that's essentially the extent of their education in EoL issues.
Since Dr. Villalobos introduced the concept of pet hospice services in 2000, interest in palliative care (relief of suffering in all areas of a patient's life), pain management and hospice for EoL Stage pets has been growing among veterinarians.
Dr. Villalobos' vision for the End of Life stage is to see the discipline of palliative medicine and hospice care become a goal of treatment rather than a brief stop on the road to euthanasia.
Unfortunately, not everyone in the veterinary profession is open to the idea of an EoL stage.
Some vets feel palliative care and hospice only prolongs the inevitable.
Others are simply uncomfortable discussing the subject.
However, that's not the way many people view the end of their pet's life.
They would gladly put off the inevitable if they could keep their pet with them, comfortable and pain-free, for as long as possible.
While some pet owners, like some DVMs, are reluctant to discuss an animal's impending death, many others are very grateful to be given options that allow them to continue to care for their pet during the End of Life stage.
Special Skills are Needed to Deal with EoL Issues
Dr. Villalobos believes vets and their staffs require compassionate communication skills to provide emotional support services to parents of pets in the End of Life stage.
The EoL stage is often a rollercoaster of emotional highs and lows, and special training is required to provide adequate support to clients, along with knowing when to refer them for counseling.
According to Dr. Villalobos, "These skills, palliation of symptoms and hospice services leading to the gift of euthanasia that assures a peaceful and painless passing mark the keystone services that differentiate EoL care from other stages of life care."
What Marks the Beginning of the End of Life Stage?
Dr. Villalobos would like to make a clear distinction between the geriatric stage and the EoL stage, regardless of an animal's age. The chronological age of a pet is not always, or even often the equivalent of her physiologic age, so it's important not to label a healthy geriatric companion animal as in the End of Life stage.
Dr. Villalobos believes the unique and distinct EoL stage should start with the diagnosis of a life-limiting disease. Many pets may look and act completely normal at the time of diagnosis, but they will have a prognosis of less than one year.
The EoL stage can occur at any age. Many young and middle age pets die of cancer. Others die of organ, musculoskeletal or neurologic failure.
There are three phases in the End of Life stage -- the early, middle and late phases.
Treatment in the early phase of EoL for pets that are still healthy and functional is often aggressive. Decision making in this phase, especially if the animal is older, is difficult. Palliative care and a transition to hospice offers an alternative to aggressive treatment for some pet owners.
If a pet is diagnosed in her last phase of life, late-phase EoL care can immediately provide all the services of hospice, which includes emotional support for the family and after-life services.
The goal in most cases for pets in the EoL stage is to get them home with their families, with pain control and palliative care. Then the veterinary team follows up with phone calls, home-care visits, and euthanasia if or when needed.
More Can Be Done to Help Families with Dying Pets
Dr. Villalobos believes that while veterinarians help clients with dying pets, much more can be done. She feels that with the designation of an End of Life stage and its special care requirements, the needs of pets and their families can be better served.
According to the doctor, "With a gentler standard of care, palliative medicine, personalized nutrition, immunonutrition, chemoprevention and love, we are likely to improve and extend quality of life for some early- and middle-phase EoL patients."
Dr. Villalobos also believes late-phase EoL patients deserve the best hospice skills available. She feels that, "Highly bonded clients and their companion animals will benefit from the honor and expertise that you bring to their unique experience."
I agree. In fact, this year I expanded my veterinary practice to incorporate a pet hospice program to support and help care for pets and their families through the end of life experience.