This is the post-lunch session of the conference, being held at George Washington University in Washington, D.C.
I am blogging this live; hit "refresh" periodically to see new material. Since this is live, there will be typos. And only things in quotation marks are direct quotes. Everything else is a paraphrase.
She said someone, a vet, she told about giving this talk was horrified that she would be turning shelter people into "death hoarders." That resources are scarce, how can you spend them on the "5 percent"?
Dr. Downing said that some of that 5 percent cannot be saved, like it not; some of those animals do not deserve to be kept living. But the question is, if there are those whose only "crime" is they are old, sick, have issues... how can we help them, and bring them under the umbrella of those who can be rehomed, rehabilitated, or re-positioned in their world?
Dr. Downing: "Dying is really hard work, and the illusion that the animal should 'die on their own' is just that... we sentence them to suffer to death." (She means unaided.)
She says some diseases are very painful, such as end-stage kidney disease. Animals do not fear not seeing tomorrow -- but they can and do fear PAIN. How do we address that? It can be done. And the no kill movement is where this is going to start.
Palliative care is a young discipline and this option will have never crossed the mind of many of the veterinarians we work with.
Foundational principles extracted from human hospice and palliative care. Humans do almost always, in this country, have to suffer to death.
Animals have the option of humane euthanasia when suffering cannot be helped.
Palliative care is a spectrum. May take hours to compleete the arc from brginning to end, or may take months or years after diagnosis with a life-limiting disease.
You are lay people and deeply committed to what you do, but she says she cannot over-emphasize the need for a veterinarian to be involved in end-of-life care, to formally assess and respond to pain.
"Hospice was created to provide symptom control, pallsitavie relief from suffering, a nd meaningful presence and human refuge..." sorry, couldn't get entire quote. Will follow up.
"Palliative care is a philosophy rather than a protocol of care."
Be flexible in delivery.
Creative thinking, planning, working with volunteers and fosterers, leverage individuals involved.
Is not expensive and usually does not involve a lot of resources. In a resource strappec rescue situation, won't be too draining.
How can you provide palliative care options?
Death is a part of life, and in hospice care we avoid aggressive interventions.
Interventions are about creating and sustaining comfort. A philosophy of care.
Hospice care can be delivered anywhere. This is about a MINDSET. You have access to volunteers who don't want to foster a young, active animal, but may be very willing to foster a 15 year old animal who has very little time left. "I happen to be one of those. I will never have a puppyagain in my life. I don't have that energy anymore at my age. And I don't want a pet to come into my life who will outlive me."
CRITICAL NOT TO ALLOW ANIMALS TO 'SUFFER TO DEATH." When we get to the place where pain is intractable and we cannot control it, and that is the time we should intervene with humane euthanasia." But ONLY then.
Recommends taking human hospice care. Available in almost every community. Free. helps prepare staff and volunteers for the nuances of dealing with animals approaching their end of life. Empowers to help animals who can't be "saved" (cured).
Many diseases are are palliated rather than cured, but many of these pets can live a long time. Diabetes, chronic renal disease -- can conditionn cats to be fine with sub-Q fluids; palliative! -- hearth disease, endocrine disease, systemic cancers.
Little fourteen year old hairless one-eyed Chinese Crested with cancer -- she's now six months out, eats, sleeps under the blankets with her people every night. In most shelters, "You've got big lymph nodes? Let's see if Jesus has your room ready for you yet."
Create a management plant that deals with as much as you can, most important things first, based on resources. This is not pie in the sky; this is fundamentals. Take an inventory, ,make a plan, pain management is the number one priority.
Recognize an animal's will to live, and when they're done. "There isn't one right answer." Continuum of care, change over time. You get to be creative and respond to things as they change over time. You need to work with a vet who can help you know when things have changed for the worse.
Multiple morbidities are common in animals.
First, treat the things we can treat.
1. Pain management
2. Comfort care
3. Quality of life Quality of life is as individual as the individual animals we're talking about! That is why quality of life assessment is so important.
MOST important piece as animal is approaching end of life is pain managment.
Need a vet to work out a targeted plan and a multi-modal strategy -- pharmacy and non-pharmacy -- to keep animal comfortable. If things aren't causing pain, don't worry about them.Pain is a moving target.
Many drugs available:
General nursing care. Attend to blowl and bladder function, pulmonary function, skin integrity (turn animals regularly)
Keep bandages clean and dry
Physical rehab techniques
Applying heat and cold - talk about cheap and easy! But need guidance to know how, when, where.
Create a personalized plan for each animal. Consider symptoms, diagnoses, caregiver resources, what will things look like as it progressed, have a crisis plan.
Make sure volunteers taking care of these animals have the support they need.
Avoid aggressive interventions, but don't withhold something simple, gentle, appropriate. This is where prioritizing options is so important.
Anticipate medication side effects.
Provide caregivers with a list of meds, how supplied, how given, frequency, how they should be stored, potential side effects. She creates laminated card, and when there's a dosing or other change, they get a laminated card.
"Pill minders" may make dosing easier.
Medication checklist to avoid medical error.
Palliative care is not about giving up nor is it care of "last resort"
Kinder, gentler standard of care.
Important, often overlooked: Help caregiver modify home environment. Can make a HUGE difference. Makes it less hard for them to stay alive.
Non skid floor surfaces --like jigsaw puzzles, made for kids, put the gray side up, not the colorful side. Easy to clean. Better than area rugs.
Access to stairs, ramps, mobility devices. Don't allow unsupervised access to stairs, including if visually or cognitively impaired.
Ensure access to family activity. keep them engaged and with the family. Minimize isolation.
Easy access to water and food.
Kitties: Low sided litter pans, potty pad sprinkled with litter. Suggests using huge sweater boxes... cats love having all that room.
"Stay dry" bedding/fabric so don't have to lay in urine
Orthopedic or memory foam
Allow pet choice of favorite locations -- including outdoor hangouts that have been made safe for them. take them there!
Keep them safe when not at home, at night.
Prepare, plan for the worst, but hope for the best. make as comprehensive a plan as possible, and do the best you can with the resources you have.
Let them live as long as they want to.
Recommends use Dr. Alice Villalobos Quality of Life Scale for Pets (on CD)
Some animals need daily assessment.
Scores 7 factors scale of 1-10. Makes it easier.
Hurt hunger, hydration, hygeine, happiness, mobility, more good days than bad.
Score above 5 in all categories or 35 and up overall, animal's QofL is probably fine.
Scoring is important, but trend over time time is more important than how an animal is on any given day.
If we find dropping scores, we want to pay attention -- can we tweak what's going on? Modify pain med? Change how handling mobility? Every pet's situation is a different.
NEED TO WORK WTIH A VET!
If multiple caretakers, each should score separately. Can be very informative.
A plan and QofL scoring can prevent bad outcome.
there is no reocncilation or spiritual enrichment to come from allowing a pet to "suffer to death." When that time comes, remember to keep humane euthanasia as an option.
Ultimate pain management strategy is a release from suffering.
The ability to breathe comfortably is a pain management issue (not widely understood).
Create a schedule for regular veterinary assessments.
Maintain VERY open channels of communication with everyone involved in care.
Note: Eye problems hurt a LOT. Many older animals don't make enough tears.
If they don't want to eat, hand feed, blender meals. Be sensitive to whether it's a sign they are done with life... but if are still enjoying other aspects of life, be creative and find ways to feed them.
Hydration is not heroic intervention! Broth, electroyte mix, sub-Q fluids.
Older animals can have hygeine problems. Watch for mats.
Puppy cut or lion cut.
Can pet move away from urine or stool accidents?
If pet is bed-ridden, keep skin clean, and turn them on a regular basis.Use fabrics that wick moisture away. Don't use clay litter that can get caught in cats' feet.
Belly bands for male dogs and cats who are urinary incontinent.
Happiness -- are they happy? Mental state of critical to QofL.
Is there joy? mental stimulation? Notice eyes and facial expressions.
Distressed and painful and fearful cats use purring as a self-medication. DO NOT BE DECEIVED and think they are purring because they're happy!
Pets are social, don't let them be isolated. Keep pets in their "pack." Including other pets if like each other. Some pets care for each other.
Mobility: Use devices EARLY -- bottoms-up leashes, wagons, snugglies, etc.
Ideally, train dogs to use ramps to get in and out of car when young.
More good days than bad? A pet "tured off" to life or with many bad days ina row, then may be close to done.
Nausea, vomiting, diarrhea, seizures, unrelenting pain, difficulty breathing.
Healthy human-animal bond is a two-way street.
IVAPM -- will get URL later.
Note: You can see yesterday's liveblogging here.