End Of Life Considerations For Your Pet

The public perception of animals as connected to humans is making the death of animals more emotional than it has been in the past. This directly ties in with the difficult and complex decisions pet owners often have to make at the end of a pet’s life. I recently attended a session on end-of-life considerations at CVC in San Diego by Elizabeth Colleran, a feline practitioner and internal medicine specialist. She said planning ahead can make all the difference, so here are 5 tips to consider when preparing yourself for the inevitable day when your pet crosses the rainbow bridge.

Anticipate Grief

When your pet has a life-limiting condition where pain cannot be managed or cured, most likely you will develop strong emotions that Dr. Colleran calls anticipatory grief. This powerful grief is the psyche’s way of preparing for impending loss and is completely normal, but it can blur judgement. It is important to plan and prepare for end-of-life considerations before this grief takes over, as your judgement can be impaired.

Discuss euthanasia procedures with your veterinarian ahead of time, and plan what to do with remains. Make sure you understand how it occurs, and ask for heavy sedation and pain control for your pet before euthanasia solution is administered. Your pet deserves a peaceful, pain-free exit, and you are your pet’s proxy and advocate.

Accurately Assess Quality of Life

In order to make the best decisions about your pet’s life, you need to accurately be able to assess quality of life. A pet’s quality of life can be measured by ability to engage in normal behaviors, eat and drink normal, maintain normal bowel and urinary habits, and express enjoyment or interaction with the pet’s people. Your veterinarian can give you a quality of life assessment scale that can help you quantify the unquantifiable. If you are getting near the end, ask your veterinarian for assistance in measuring quality of life, as that will help you base your decisions on real-life measurements.

Keep Files in Order

Ask your veterinarian for up-to-date veterinary records, and keep a copy at home. If your pet needs treatment or euthanasia while your regular veterinary office is closed, it will be important to have these records to share with an emergency/after-hours clinic.

Decide Whether to Have Children Present

Decide before-hand whether you want to have children affiliated with the pet present. Euthanasia can be a traumatic event for young children, so consider having them say goodbye before the veterinarian administers the euthanasia solution. Remember that children under the age of 10 think concretely, so using language like ‘putting a pet down’ or ‘putting a pet to sleep’ will not communicate that death has occurred. Use concrete language.

Memorialize

People don’t often understand the depth of connection between a pet and his/her owner. When a pet passes, it is important to honor the relationship, the care you gave, and the love you shared. Consider how you will memorialize your pet - be it with candles and music, planting a tree, spreading ashes, telling stores, etc. This is an important final step in the journey, and will help everyone involved grieve and celebrate the special life that has passed.

Do It Yourself For Pet Owners

Being a pet owner means getting your hands dirty, even just a little bit. There are several DIY procedures that are a must-know for modern-day pet owners interested in the best health for their pet.  These tips can help your veterinarian and can improve the health of your pet!

Record Your Pet in Action

Pet parents will often schedule appointments for problems with their pets that don’t happen all the time, i.e. an intermittent limp, coughing at night, a bizarre reverse sneeze, seizure-like activity, or other weird behavior that simply can’t be replicated at the vet’s office, usually because the pet is too ramped up. In these cases, it is very helpful to take a video or a photo on your smart phone and show that to your veterinarian.

Groom

Some pets require more attention to their skin and coats than others, especially if they have nasal or tail folds or long hair around their muzzles or nether regions, then those areas need to be inspected and possibly wiped with a cleansing wipe to remove debris.  If you have an older female dog who struggles with urine leakage, then wiping around the vulva once daily with an apple cider wipe can help prevent lower urinary tract infections and excessive licking.  Baby wipes are also great tools to clean away debris from skin folds and away from eyes.

Teeth Brushing

At home dental care is the cornerstone of dental health for your companion animal. I believe all owners should start young with teeth brushing to prevent periodontal disease and tooth loss. You can also keep your pet’s teeth clean by using dental wipes instead of a toothbrush, if that is easier. Simply wipe along the outside of the teeth, making sure to go all the way to the back molars. The reason I recommend starting young is that it is easier to train a young dog to be used to someone messing with her mouth than an older dog. Follow-up brushing sessions with a dental treat for positive reinforcement of this important at home health regimen.

Puppy Pedicures

Just like teeth brushing, it is much easier to teach younger dogs to have their paws touched and their nails trimmed, but with patience and time, most paw-shy pups can be taught to handle nail trims. If your dog suffers from toe infections call pododermatitis or if your dog works her feet in athletic endeavors, then consider giving your dog a puppy pedicure. You can soak her feet in a warm Epson salt solution, massage shampoo in between the toes, and apply a moisturizing humectant to the paws.

Collect Samples

Everything from fleas, to ticks, to urine or feces: a pet owner should know how to collect these lovely specimens and bring them into their veterinarian, especially if their pet is sick. It’s gross, I know, but remind yourself: it’s for your pet’s health. When your pet goes in for his or her annual exam, your veterinarian will (or should) ask for a poop sample to test for parasites, many of which are human health risks. If you bring in a sample that you have collected from home, then you will save your pet from the dreaded fecal loop and trust me: NOBODY likes using that thing.

Putting poop and parasites in a plastic bag and sealing them is pretty self explanatory: make sure to wash your hands. Sometimes, such as in cases of diabetes, urinary tract infections or other changes in urination and water consumption, you may need a urine sample. To catch a urine sample from your dog, follow her out when she goes to do her business, and catch urine in a tupperware.    
Even though fresher is better, sometimes you have to collect samples the day before your veterinary visit. If you do, then store them overnight in the fridge. Urine samples are especially important to collect fresh, as the longer the urine sits, to more likelihood it is going to change.

Fear Free

Have you ever been embarrassed about how your pet acts at the vet? Many pet parents apologize to me about their pet’s behaviour at our veterinary hospital, saying how they can’t believe that Fluffy is growling and hiding under the chair, or that their pet really does have manners and knows how to sit.  Unfortunately, some clients will elect to forego crucial veterinary care entirely because their pets are so fearful at the hospital.  It is just too difficult and stressful.

It is important for pet parents to know that when your pet misbehaves, the veterinary staff understands.  When an animal is at the vet clinic, he is not in his right mind. I know how I feel at the dentist, and I know what is going on, so imagine how your pet feels!

In veterinary medicine, we are finding out that your pet’s emotional well-being is as important as his or her physical well-being, and part of that is reducing the fear and stress associated with veterinary visits so that your pet can get the care he needs. While veterinary hospitals are modifying their protocols to help pets feel more comfortable, there are also steps you can take at home to make vet visits go more smoothly.

Relaxation starts in the car. Long before the day of your veterinary visit, get your pet used to carriers and car rides.  Let cats use their carriers daily as a resting place so it is familiar, and make sure the carrier is level in the car by placing a towel under the carrier.  If your dog shows signs of carsickness (vomiting, drooling, acting anxious) talk to your veterinarian about anti-nausea medication that you would administer before your pet gets in the car.

Use pheromones, calming nutraceuticals and music to calm your pet. To help pets relax on the day of your appointment, use Adaptil or Feliway pheromone spray and calming supplements such as l-thianine. Try playing music specifically designed to reduce stress in pets, such as Through a Cat’s Ear and Through a Dog’s Ear, available on iTunes.

Limit food before your veterinarian visit. There is a lot of research that shows eating lowers anxiety and produces feel-good endorphins. I feel like I would be happier at the doctor if they gave me an ice cream cone when they were giving me a shot! If they don’t already, ask veterinary staff to feed treats all the way through the visit.

Minimize waiting room time.  Waiting rooms can be stressful. Imagine a terrified Maltese getting stared down by a Doberman! Weather permitting, check in with the front staff and then go get your pet from your car when you can be ushered directly into an exam room.  If your vet clinic has an outdoor area, let your pet wander on leash and sniff pee-mail.  If weather prohibits you from leaving your pet in the car for a bit, ask if you can wait in an exam room.

If you pet has severe anxiety or fear aggression, talk with your veterinarian about sedating early in the visit, or even before the visit. Some of my clients administer alprazolam at home before coming: it’s the equivalent to someone who has a fear of flying taking a Xanax before getting on a plane.

Just breathe.  A calmer client equals a calmer pet. Our pets perceive our anxiety and will pick up on it, so when you are at the veterinarian, practice slow, deep breaths and calm behaviour around your pet so that your pet can relax. Be calm, so your pet can be calm.

Vomiting cats – is it normal?

Chronic, occasional vomiting in cats can be a great frustration to clients and veterinarians, and despite what Dr. Google says, it is NOT normal for cats to vomit on a regular or even semi-regular basis. Unfortunately, vomiting cats are so common that many pet parents (and even some veterinarians) have accepted it as the norm.

Small animal internal medicine specialist and veterinary author and lecturer Dr. Norsworthy says that there are usually a couple of common explanations that pet parents give for cat puke:

1. He eats too fast.
2. She has a sensitive stomach.
3. They're just hairballs, and they are normal.
4. That's just the way he is, or, as one of our clients put it, "He's just a puker."

While buying one or more of these excuses, we should ask ourselves if one of our human family members were vomiting this often, would we accept it or would we seek a diagnosis and proper treatment?

Chronic kitty vomiting is not normal, and the cause of the vomiting needs to be investigated.  Often, the cats can be sick over many years, and the only sign is vomiting, and maybe very slow weight loss.  This reason for this is the two most common causes for vomiting in cats, IBD (inflammatory bowel disease) and lymphoma (cancer of the gastrointestinal system) are slowly progressive diseases. Fortunately, there have been huge strides in determining the cause of vomiting in cats in the past couple of years, and veterinarians are now able to help cats that were formerly doomed to a lifetime of disease.

Researchers have determined that rather than a stomach disease, most of the cats suffering with chronic vomiting have inflammatory or cancerous conditions in the small intestine, and the only way to diagnose this conditions are with abdominal ultrasound and intestinal biopsy. The good news is that if the condition is diagnosed and treated early enough, we have a chance of preventing progression, saving hundreds of dollars in treatments, and increasing the quality and quantity of life for cats.

So what is the next step?  My hope is that now we have identified the cause of chronic vomiting in cats, we can explore what is the cause, or causes, behind these diseases. Currently, the cause of IBD and GI lymphoma in cats is unknown. Genetics may play a factor, dietary causes are suspect, and chronic stress are all being examined. In our lifetime, we may be able to uncover the root cause and instead of treating the disease, prevent it in the first place.

Cancer in pets: Don’t panic!

November is ‎Pet Cancer Awareness Month and just like people, pets can get cancer. Pet parents are usually the first to detect a small bump on their pet’s skin, and most people make an appointment with their veterinarian immediately to have it evaluated.  Before you hit the panic button, however, I want to let you know that even if the bump turns out to be cancerous, you shouldn’t automatically assume the worst.

Skin tumors in dogs range from non-cancerous cysts and moles to cancerous growths like mast cell tumors or soft tissue sarcomas.  When your veterinarian evaluates the growth, he or she will assess it in several ways. First, whether the lump is on the skin or under it. Next, the size and color of the lump, and how firm or freely moveable it is. Whether your pet has had other growths in the past is also important, as well as whether they were removed and biopsied.

Skin growths are assessed by either a fine needle aspirate: poking the mass with a needle, removing some cells and sending them to the lab to be evaluated, or by a biopsy, where a piece of the growth is removed or the whole growth is removed and sent to the lab for evaluation.

Tumors are assessed for the type of cells and the grade of malignancy, which means how quickly is the tumor growing based on cell activity that is seen on the microscope slide. If the tumor was removed entirely during surgery, the edges or the ‘margins’ of the tumor are also evaluated to make sure that the edges are free of cancerous cells. If there are cancerous cells left behind (not visible to the naked eye), then the tumor will grow back, and the area needs a second surgery to remove all traces of cancer. Depending on the type of tumor, the surgical area may look a lot larger than you expect. Soft tissue sarcomas, for example, extend rafts of cancer cells out from the tumor, attacking healthy tissue with microscopic tentacles of cancer. In order to remove all of the disease, the incision has to be much wider.

Some skin cancers respond well to radiation or chemotherapy, which is as available for pets as it is for people.  The good news is that pets don’t suffer the same negative side effects from chemo as people do, such as losing their hair or having gastrointestinal problems.

If the growth is a small cyst, mole, or fat-growth called a lipoma and not causing your pet any pain or irritation, your veterinarian may elect to leave it alone and simply monitor it for changes.  The best way to help your pet stay cancer-free is to conduct monthly lump checks when you are petting your cat or dog. Simple run your hands all over your pet feeling for anything out of the ordinary, and if you feel a growth - schedule an appointment to have it evaluated by your veterinarian. In the meantime, don’t panic. Chances are it isn’t a malignancy, but even if it is, there are good veterinary treatments available to help your pet live a long and healthy life.

Winter hiking with your dog

Just because the temperatures have dipped doesn’t mean outdoor fun is over for the year. On the contrary, you can have just as much if not more outdoor adventure with your dog in the winter as in the summer, the rules just change a little to make winter hiking safe and fun.

Before you go, make sure you have supplies for your dog. When we hike I pack water, dog snacks, dog waste disposal bags, a collapsible bowl, a dog jacket and boots. A hands free leash is also nice.

Just like people, dogs need conditioning before they hit tough trails. Signs of exhaustion and dehydration, like panting, red gums, vomiting, or sitting down and not moving are all clues to rest, rehydrate, and evaluate on whether you need to turn back the hike.
 
Winter weather protection is very important for dogs with short coats.  A shivering dog is too cold - prevent hypothermia by outfitting your dog with a jacket. You can even layer a pack over a jacket. Frostbitten skin looks waxy, white, or leathery - if you notice frostbitten skin, seek veterinary care immediately.  Ear tips and webbing between toes is most at risk.  Protect your dog’s paws against the elements with rugged boots. Dog boots prevent snow buildup, but another alternative is to rub baby oil on and between the toes and pads.

Even though it is cooler out, it is important to keep your dog cool and hydrated. Since dogs cool off by panting and by sweating through their pads, it is necessary to occasionally remove boots and allow the paws to breathe, even if it is cold outside. You can also check the paws for sores or abrasions when you do this.

During strenuous activity and hikes at altitude, your dog will need extra hydration.  If you dog wears a pack, she can carry her own water.  On hikes, stop for a snack every 45 minutes - trail mix for you, kibble or treats for your dog.

Hiking during the fall and winter also means hunting season, but even though you will need to take some precautions before you hit the trail, hunting season doesn't mean you have to stay home.  First, check the rules for your area. Generally, archery and gun seasons start in October and runs through January, but seasons varies from location to location.

Overall, hunting accidents involving hikers are rare.  The single most important precaution you can take during hunting season is to make sure you and your dog are visible by wearing bright colors, preferably orange. Your orange should be visible 360° around your body, from all angles.

You can buy cheap blaze orange vests at any store that sells hiking gear or sporting goods. Blaze orange hats are good too. Around Halloween, a lot of places sell bright orange trash bags that you can use as pack covers. Try to avoid wearing brown or white gloves or socks, which could be mistaken for the flash of a deer's tail.

Dogs should also be outfitted with a blaze orange collar, scarf or vest. If your dog runs around off trail or chases game, keep her on a leash. In fact, you should both stay on the trail; hunting season is not the time for bushwhacking. Most trails are considered safe corridors and hunters should refrain from shooting on or near established footpaths, but still, better safe than sorry.

Lumps: should you be concerned?

One of the most common reason pets are brought in to see their veterinarian is for skin issues. One of the more frightening symptoms is unexplained lumps and bumps on the skin, under the skin, or sometimes in the mouth.  Most of the time, the cause of the swellings is something benign: fluid-filled cysts, fatty tumors, warts, skin tags, and histiocytomas are all lumps that are benign and usually ok to monitor at home. They can still grow, get infected or make the pet uncomfortable, but they aren't cancer or require emergency treatment.

Other times a lump can signal a more serious condition that requires treatment. Bumps that are painful and appear suddenly can be due to an abscess, which is an infection usually caused by a bite wound. Pets can also get skin cancer, just like people. The worst cause of a lump is a malignant tumor because these lumps can spread to other areas of the body.

If you notice a lump on your pet, monitor him or her at home. If your pet seems to be acting normally and the lump isn’t painful, red, or giving off a bad odor, then it is mostly likely not an emergency situation.  Call your veterinarian and make an appointment to have it checked.  If you mark the mass with a sharpie pen, that will help your veterinarian locate the swelling.  On the other hand, if your pet isn’t acting normal, is tired, doesn’t want to eat, or is limping, etc., then you might be dealing with a more urgent situation.

Your veterinarian is in charge of figuring out what the lump is, and what to do with it.  Your veterinarian will most likely ask you questions about when you first noticed the swelling, if it has changed at all, and how your pet has been feeling otherwise.  These questions are the history that will help your vet determine the scope of the problem.

Your vet will then examine your pet.  The look and feel of a lump can tell a veterinarian a lot about what your pet is dealing with, but don’t be surprised if your vet also examines your pet from head to tail.  A thorough physical exam is critical to assess your pet’s overall health and determine if there are any lumps anywhere else.

Once your vet has examined the lump, he or she will most likely offer several options to diagnose or treat the swelling.  The vet might recommend cytology of the lump, which is a simple test where a needle is inserted into the swelling.  The goal is to extract a few cells that can be viewed under the microscope; often a veterinarian will send the sample out the lab for analysis.  The drawback of cytology is that it only can give limited information, which is why your veterinarian may also recommend a biopsy.

There are two types of biopsies:  incision and excisional.  With incisional biopsy, a small bit of the mass is sampled and sent to a laboratory for analysis.  Excisional biopsy involves removing the entire swelling and sending the whole mass in for analysis. Depending on the mass size, location and the temperament of your pet, your veterinarian will recommend local anesthesia (numbing the area) or general sedation.

Treatment depends on the underlying cause of the lump, and can range from lancing and draining (for abscesses), to minor surgery, to something more invasive if the swellings are due to a serious underlying medical problem, like cancer.  It is also entirely possible that your veterinarian may determine through physical exam alone that the swelling is no danger to your pet and purely cosmetic, and give you the option to monitor it at home.  Again - your veterinarian will be your greatest resource, so if your precious pet has an unidentified swelling, schedule an appointment ASAP.