End of Life Care – A Veterinarian’s Perspective

end of life care

end of life care

I have been practicing veterinary medicine for over three decades.  The advancements in diagnostic testing and treatment options that I have seen developed for companion animals has truly been amazing.  Unfortunately we often still will reach a point where further intervention does not benefit the pet and at that time, it becomes the veterinarian’s job to counsel the family as to their options and prevent suffering of their patient.  This is definitely one of the most challenging aspects facing the veterinary health care team.

Putting a pet to sleep is not the hardest part of the job

Our practice treats a large number of aging dogs and cats with a variety of chronic, debilitating conditions and our goal is to preserve the quality of our patients’ lives, prevent painful conditions, and help the family make the End of Life Care a Veterinarian's Perspectivedifficult decisions that lie ahead.  While people often say, “Putting a pet to sleep must be the hardest part of the job”, I disagree and tell them that since we only perform euthanasia when it is appropriate, it is much easier than the journey that gets us to that final visit.  Whether it is in our office, or as an in home visit, euthanasia is a procedure that allows us to fulfill our obligation to our patients to keep them free of pain and suffering.

The decision does not come easily for families and I am often asked, “How will we know when it is time?”  As a younger veterinarian, I often passed the buck on this one and would tell owners that they will know when it is time.  However, as I have gained experience in palliative and hospice care, I do not think that this is the situation and owners often need guidance.

The four stages of “end of life” care

Our practice of end of life care is based on four stages. 

Stage One

The first is to encourage owners to pursue an accurate diagnosis.  This is important because many chronic diseases are not terminal in the short run.  Finding out exactly what type of illness we are dealing with is important so that we can offer a realistic prognosis and develop the best treatment plan. Some illnesses lend themselves to successful intervention which can lead to a cure or at least a meaningful extension of a quality life for some period of time.  Others have a guarded prognosis for any humane existence beyond the immediate future.

Stage Two

Old age in itself is not a disease and once a specific diagnosis and prognosis are established, the veterinarian and family need to have a frank discussion about their particular situation.  Armed with facts, the road forward can be End of life care a veterinarians perspectiveestablished.  If curative treatment is not a realistic option, owners can opt for palliative care.  Many animals that enter our palliative care program are not currently critically ill or dying. Their disease, although serious, has not progressed to the point that they cannot continue with their daily routines, although often at a somewhat reduced level. Our goal is to maintain or improve quality of life for both the pets and their family. The most common conditions that we treat with palliatively include chronic kidney disease, severe arthritis, neurologic conditions, heart disease, and cancer. The emphasis is on control of pain, maintaining body condition through exercise and nutrition, and slowing the progression of the disease process.

Stage Three

Once we are not able to provide palliation of the clinical signs of the disease process, we move into the third stage, hospice care.  Our hospice patients are terminally ill, and rapidly losing the ability to lead a quality life.  While end of life care for senior dogshospice care can technically be provided on an inpatient basis, we do not currently provide that for our patients.  Our hospice patients are cared for at home, by their families, with the guidance of our veterinary professional staff.  Home visits by doctors and licensed technicians help design a hospice program that prevents pain and suffering as long as possible.  It is imperative that our staff and the family work as a team, during this intensely stressful period. While we sense the desperation of our clients as they try to find a way to prolong the life of their beloved pet, we encourage our clients to be realistic about their pet’s condition and discourage prolonging life beyond the point that is humane.

Stage Four

When we reach that point, we come to the final phase of our end of life care, euthanasia.  This is a discussion that is started at the beginning of hospice care so owners are prepared.  Veterinarians have taken an oath to prevent end of life care from a veterinarians perspectiveanimal suffering and we often are required to offer an objective evaluation as to the condition of a pet. Our doctors and staff have a deep sense of compassion and have all had to make that difficult decision when it became apparent that our own dogs or cats were terminal and suffering.  Humane euthanasia, either in our office or in our client’s home is never an easy decision, but rather, one that after introspection is the kindest thing that we can do for our pets.  While we hope that they will pass quietly in their sleep, this is often not the case and prolonged suffering is a cruel end to a long life for a beloved companion.

So, while euthanasia is often the final service that a veterinarian can provide for his or her patients, it is not the hardest part of the job.  The road to this point is much more difficult as we often have to bear witness to human anguish and animal suffering.  Our team’s goal is minimize both, empathizing with both the family and the patient, and providing a humane alternative for end of life care.

 

 

Dr Keith Niesenbaum and Bella

Dr. Keith Niesenbaum received his veterinary degree from The University of Pennsylvania in 1984 and practiced as an associate veterinarian for 5 years before starting Animal Bedside Care, a veterinary house call practice on Long Island, NY.  The practice grew and he has owned several animal hospitals and a boarding kennel in the intervening years.

He currently owns and practices at Crawford Dog and Cat Hospital in Garden City Park, New York. The practice emphasizes low stress, fear free visits and incorporates house calls as part of its regular service menu. Doctor Niesenbaum has special interests in wellness care and the early detection and prevention of diseases, especially in older pets.

Outside of practice, is often seen riding his bike or running with his dog, Bella who has recently become a bit of a Facebook video sensation

 

End of Life Care – A Veterinarian’s Perspective

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17 thoughts on “End of Life Care – A Veterinarian’s Perspective

  1. I do not think that however much we speak about it, we are never really prepared for it but on the other hand I do firmly in putting a pet to sleep so that they will not suffer anymore. I remember when I had to make that decision for Baby or my cats before then, I sat and cried like a baby but in my heart I knew it was the best thing to do. Great post and I admire vets on a daily basis.

    1. I agree with you Ruth. You can talk about it, think about it, know it’s going to happen but when the time comes we all end up in heaps on the floor. Your animals are lucky you think only of their quality of life, and don’t allow them to linger because it’s too tough to let go.

  2. Such an important topic that many pet parents have a hard time talking about. I’ve been through it myself and assist my clients when they go through it. I love the approach that this vet takes in his practice and that he and his staff have so much compassion for such a difficult part of loving our pets.

    1. Hi Christine, I agree with you, it is such an important topic but a tough one. I also love the approach Keith takes. He seems to have so much compassion for the journey we take as senior dog parents, and is so much more connected than any other vet I’ve ever been to. I wish he was my vet because I’m sure he could help me figure out the quality of life issues I’m facing with my sweet Red.

      1. Thanks for the kind words. Not only to I have a practice with many senior pets, I had a senior dog that I eventually had to put to sleep. So I know what owners go through.

        1. Hi Keith, I would imagine your clients are very lucky to have you as their vet because you seem to have a lot of experience treating seniors, not to mention having compassion for them.

  3. Dr. Niesenbaum sounds like a wonderful and compassionate vet. I like his approach in starting the discussion early. That’s interesting about how his perspective changed from early in his career – telling his patients they would would know when it was time to now making it more of a discussion.

    We found a wonderful hospice vet who visits animals in the home. He helped us so much with our cat Elsie who passed away at home in September 2016.

  4. We are never ready to let go but I am also a firm believer of euthanasia and if Layla gets to the point where she has no more quality of life for whatever reason, I would let her go. It would kill me but in my heart also I know she would not be suffering. I learned how to deal with this when we took my father off life support as he had no quality of life left in him, and to this day, 20+ years later I am happy we did it as he died with respect.

    Hope that makes sense.

  5. Interesting viewpoint and he explains it well. Working as closely as I do with veterinarians is wonderful, and I see just how much they care about their clients. We have a local company called Lap of Love (it may be franchised) that performs hospice and euthanasia for pets in the comfort of their own home. It is a true testament to their passion to help these animals cross the Rainbow Bridge.

  6. End of life is always the most difficult thing. I believe that every decision should be individual to the family, to the dog, and to the prognosis.

  7. No one wants to think about the final stages of their beloved pet’s life, but it is important to be prepared, as our pets will usually leave us before we leave them. This is very informative, thank you for sharing.
    Love & Biscuits,
    Dogs Luv Us and We Luv Them

  8. This is such an important topic, but a hard one to accept. I wish I’d had hospice care available for my previous cat when she’d been diagnosed with cancer and was given only a few months to live. I remember taking her back to the vet one day and the vet saying, “are you ready to let her go?” The question threw me because I thought I had more time. The vet told me she would probably see me the next week. This was on a Thursday. One Friday, my girl stopped eating. On Monday, she was helped to the Bridge. It was a difficult decision, but one that was best for her.

  9. As a long-time dog owner, I think there are two really hard stages. The first is getting the diagnosis that your pet could die from whatever disease he has. Just knowing that whatever ails the pet is not a quick fix with a pill. The second stage is making the decision to euthanize the pet – this is the hardest of the two. How many times I think it is time, and then the dog seems a bit better, only to go further downhill a day or so later. It’s the hardest decision to make – but often I feel better after I have made the appointment with the vet.

  10. It is always hard to say goodbye to a loved one, but I think euthanasia is a very compassionate act when a pet is suffering from a terminal illness.

  11. I hadn’t thought about elderly dog care as having that many stages. However, he gave good parameters for each stage and that will be helpful for me to think about. Really good article! (YAYDog Clare)

  12. As someone currently caring for a senior pet, this is really information to have. I do see Gracie slowing down and know this is a bridge we will have to eventually cross. Right now she is still healthy and active. I want to give her the best life I can give her. Free of pain and hurt as much as I possibly can.

  13. Oh boy, this post really got me. One of my best friends is having to go through this right now. From what she tells me, I believe it is time. Her vet however is telling her that it is not time yet. We rely so much on our vets and trust their advice. I’m not an expert and I’m four hours away. Ultimately, I hope that Lucy’s suffering will not be prolonged and that she and my friend are both able to find peace when the time comes to make that decision.

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