Hospice and palliative care for companion animals : principles and practice

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Bibliographic Information

Hospice and palliative care for companion animals : principles and practice

edited by Amir Shanan, Jessica Pierce, Tamara Shearer

Wiley Blackwell, 2023

2nd ed

  • pbk.

Available at  / 2 libraries

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Note

Previous edition: 2017

Includes bibliographical references and index

Description and Table of Contents

Description

Hospice and Palliative Care for Companion Animals A thoroughly updated and expanded new edition of the only book providing comprehensive treatment of hospice and palliative care in veterinary medicine Animals with life-limiting illnesses deserve compassionate, thoughtful, end-of-life care. Their caregivers and families, faced with the loss of a beloved companion, deserve empathy, support, and education, to guide them through an emotionally wrenching period and provide their companion animals with the highest possible quality of life. In recent years, the ethics of care and service to sick and dying animals and their caregivers has been the subject of considerable attention. Hospice and Palliative Care for Companion Animals, 2nd Edition provides a thorough update to the first and only complete guide to this field of service, its foundations, and its applications. It addresses the needs of pets, caregivers, and veterinary professionals alike, including fundamental ethical and emotional principles as well as detailed discussion of specific illnesses and life-limiting conditions. The expanded second edition incorporates cutting-edge research into animal behavior and cognition to enrich the reader’s understanding of companion animals’ emotional needs and their experience of illness and death. Hospice and Palliative Care for Companion Animals, 2nd Edition readers will also find: Existing chapters expanded to incorporate new research and practical experience New chapters discussing factors underlying the decision to euthanize, the potential role of ethology in palliative care, and more A companion website with educational handouts for use in veterinary practices Hospice and Palliative Care for Companion Animals is an indispensable resource for caregivers and veterinary professionals alike.

Table of Contents

List of Contributors xxi Acknowledgments xxiii About the Companion Website xxiv Part I Core Concepts 1 1 Introduction 3 Pierce, BA, MTS, PhD References 5 Further Reading 5 2 What Is Animal Hospice and Palliative Care? 6 Amir Shanan, DVM and Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, MSTCVM Introduction 6 History of Animal Hospice 8 Scientific and Philosophical Roots 8 Early Beginnings 9 Organization and Recognition 10 Animal Hospice and Human Hospice 12 Ethical and Legal Differences 12 Economic Differences 13 Summary 14 References 14 3 The Interdisciplinary Team 16 Tammy Wynn, MHA, LISW, RVT, CHPT and Amir Shanan, DVM Interdisciplinary Teams in Human Hospice and Palliative Care 16 Interdisciplinary Teams (IDT) in Animal Hospice and Palliative Care 17 Operating a Successful Interdisciplinary Team 18 Common Mission and Vision 18 Team members, Their Roles, and Responsibilities 19 Effective Communication and Collaboration 22 Summary 25 References 25 4 Quality of Life Assessments 26 Jessica Pierce, BA, MTS, PhD and Amir Shanan, DVM What are Quality of Life Assessments and Why are they Important in End- of- Life Care? 26 Definitions of Quality of Life 26 Quality of Life and Well- being 27 Quality of Life Assessments and Euthanasia Decisions 28 The Importance of Context in Quality of Life Assessment 28 Quality of Life and Patient- Centered Care 29 Physical Discomfort, Emotional Distress, Pain, and Suffering 30 Coping and Adaptation 32 Measuring Quality of Life in Animal Patients 33 A Variety of Approaches to QOL 34 McMillan’s Affect Balance Model 35 Weighing Positive and Negative Affect at the End of Life 36 Quality of Life Assessment Tools 36 Quality of Life Assessment Over Time 38 Summary 40 References 40 Further Reading 42 5 Recognizing Distress 44 Emma K. Grigg, PhD, CAAB, Suzanne Hetts, PhD, CAAB, and Amir Shanan, DVM Stress, Distress, Emotions, and Suffering 44 The Stress Response 44 What Is Distress? 45 Behavioral Needs of Dogs and Cats 46 Assessing Quality of Life in Nonhuman Animals 47 Relevance to Animal Hospice and Palliative Care (AHPC) 48 Are Humans Adept at Recognizing Emotional States in Animals? 49 Body Language of Fear, Anxiety, and Pain 49 Fear- and Discomfort- Related Body Postures Commonly Observed in Dogs and Cats 49 Pain- Related Facial Expressions Commonly Observed in Dogs and Cats 51 Relevance to Animal Hospice and Palliative Care (AHPC) 52 Changes in Behavioral Patterns as Indicators of Pain and Distress 53 Do Animals “Hide” their Pain? 53 Decreased Response to and Engagement with their Surroundings 54 Unusual Patterns of Movement or Positioning 55 Focused Attention to One Specific Body Part 56 Displacement Behaviors 56 Can Sick Animals Suffer from Boredom? 56 Relevance to Animal Hospice and Palliative Care (AHPC) 57 End- of- Life Decisions 57 Conclusion 58 References 58 6 Balancing Efficacy of Treatments Against Burdens of Care 62 Kristina August, DVM, GDVWHM, CHPV Establishing the Goals of Care 63 Assessing Efficacy and Burdens of Medical Treatment 66 Assessment of Treatment Efficacy 66 Appetite and Hydration Needs at the End of Life 66 Emotional Well- Being 67 Animal Individual Preferences 67 Do- Not- Resuscitate and “Advance Directives” 67 Assessment of Treatment Burden 68 Assessing Diagnostic Procedures 69 Adverse Events: Treatment- Related Consequences 70 Steroids and End- of- Life Care 71 Adverse Events: Indirect Consequences of Medical Care 71 Assessing the Burdens of Caregiving 72 Conclusion 73 References 73 7 Ethical Decision- Making in Animal Hospice and Palliative Care 76 Jessica Pierce, BA, MTS, PhD and Amir Shanan, DVM A Method for Moral Decision- Making 77 Part 1: Clinical Considerations and Their Moral Dimensions 77 Part 2: Patient Considerations: How the Animal Feels and What the Animal Wants 78 Understanding What Animals Want 79 Will to Live 79 Respecting What Animals Want 80 Suffering 80 Part 3: Human Factors Influencing Moral Decision- Making 83 Providing Adequate Information 85 Guiding Client Decision- Making: How Much Is Too Much? 86 Guiding the Choice between Euthanasia and Continued Palliative Care 88 Societal Ethics and the Role of Cultural Values 90 Ethical Business Practices 91 Moral Stress, Decisional Regret, and Mental Health 91 Conclusion: Finding the Path of Least Regrets 92 References 93 8 Supportive Relationships: Veterinarians and Animal Hospice Providers’ Nonmedical Roles 95 Amir Shanan, DVM and Laurel Lagoni, MS Defining the Nonmedical Roles of Veterinary Professionals and Other Animal Hospice Providers (except licensed mental health professionals) 98 The Role of Source of Support 98 The Role of Educator 100 The Role of Facilitator 100 The Role of Resource and Referral Guide 101 Resources 101 Extended Services 102 Limiting the Role of Animal Hospice Veterinary Professionals and Other Providers (except licensed mental health professionals) 102 Know Thyself, Healer 105 Conclusion 105 Grief Support Resources 106 Memorials and Grief Support Resources 106 Counselors and Grief Support 106 Grief Support Training 106 Books for Caregivers 106 Books for Veterinarians 107 References 107 9 Management and Administration: Business Models 108 Kathleen Cooney, DVM, MS, CHPV, CCFP Guidelines for Animal Hospice and Palliative Care Practice 108 Service Delivery Models 109 Model 9.1 Hospice in the Veterinary Hospital Setting 110 Model 9.2 Hospice with Specialized Mobile Veterinarians 112 Model 9.3 Animal Hospice Case Managers 113 Model 9.4 Animal Hospice Sanctuaries/Rescues 114 Practicalities of Starting an Animal Hospice Service 114 Telehealth as a Bridging Component for all Models 117 Conclusion 118 References 119 Part II Patient Care 121 10 Cancers in Dogs and Cats 123 Alice Villalobos, DVM, FNAP and Betsy Hershey, DVM, DACVIM (Oncology), CVA Approach to End- of- Life Cancer Patients 124 Tumors of the Skin and Soft Tissues 124 Canine Lymphoma 125 Head and Neck Cancer 126 Oropharyngeal and Neck Tumors in Dogs and Cats 126 Nasal Passage Cancer 127 Brain Tumors 127 Cancer of the Skeletal System 128 Abdominal Tumors 129 Hemangiosarcoma in Dogs 129 Transitional Cell Carcinoma 129 Hepatic, Pancreatic, Intestinal, Adrenal, and Renal Cancer 130 Chest Cavity Tumors 130 Palliative Cancer Medicine 131 Advances in Noninvasive Technology for the Diagnosis of Cancer 134 Summary 135 Conflicts of Interest 135 References 135 11 Integrative Therapies for Palliative Care of the Veterinary Cancer Patient 138 Betsy Hershey, DVM, DACVIM (Oncology), CVA Nutrition and Food Therapy 138 Herbs and Supplements 141 Herbal Supplements 141 Antioxidants 143 Medicinal Mushrooms 143 B Vitamins 143 Digestive Enzymes 144 Probiotics 144 Vitamin d 144 Omega- 3 Polyunsaturated Fatty Acids (PUFAS) 145 Curcumin 145 High Dose IV Vitamin C Therapy 145 Acupuncture 146 Manual Massage Therapies 147 Energy Therapy (Biofield Therapy) 148 Sound Therapy 148 Reiki, Therapeutic Touch, and Healing Touch Therapies 148 Ozone Therapy 148 Hyperbaric Oxygen Therapy 150 Cannabis and Cannabidiol (CBD) Oil 151 Essential Oils 154 Homeopathy and Homotoxicology 155 Chiropractic 156 Photobiomodulation Therapy (PBM) 157 Summary 158 References 158 12 Chronic Kidney Disease 163 Shea Cox, DVM, CHPV, CVPP and Christie Cornelius, DVM, CHPV Description of Disease 163 Disease Trajectory 163 Clinical Manifestations of Disease 163 Management 164 Management of Factors that Accelerate Chronic Kidney Disease Progression 164 Dehydration 164 Nonregenerative Anemia 164 Systemic Hypertension 165 Proteinuria and Activation of the Renin–Angiotensin–Aldosterone System 165 Renal Secondary Hyperparathyroidism 165 Symptomatic, Supportive, and Palliative Therapies 166 Oral Ulcerations and Uremic Gastritis 166 Nausea/Vomiting 166 Constipation/Obstipation 167 Loss of Appetite 167 Urinary Tract Infection 167 Hyperphosphatemia 168 Hypokalemia 168 Seizures 168 Dietary Considerations 168 Other Comfort Measures 168 Conclusion 168 References 169 13 Congestive Heart Failure 171 Shea Cox, DVM, CHPV, CVPP and Christie Cornelius, DVM, CHPV Description of Disease 171 Disease Trajectory 171 Clinical Manifestations of Disease 171 Palliative Management 172 Pulmonary Edema/Cardiac Function 172 Diuretics 173 Ace Inhibitors 173 Positive Lonotrope, Vasodilator 174 Calcium Channel Blocker 174 Pleural and Abdominal Effusion 174 Hypokalemia 174 Prerenal Azotemia 174 Balancing Renal and Cardiac Disease 174 Coughing 175 Respiratory Distress 175 Aortic Thromboembolism 175 Dietary Considerations 176 Heart- Gut Interactions in Heart Failure 176 Other Considerations 176 Conclusion 176 References 176 14 Respiratory Distress 178 Cheryl Braswell, DVM, DACVECC, CHPV, CHT-V, CVPP Airway Collapse 178 Description 178 Trajectory/Prognosis 179 Manifestations 179 Management 179 Pharmacologic 179 Physical 179 Nutritional 180 Surgery 180 Brachycephalic Airway Obstruction Syndrome 180 Description 180 Trajectory/Prognosis 180 Manifestations 181 Management 181 Pharmacologic 181 Physical 181 Nutrition 181 Surgery 181 Airway Inflammation 181 Description 181 Trajectory/Prognosis 182 Manifestations 182 Management 182 Pharmacologic 182 Physical 183 Nutritional 183 Pneumonia 183 Description 183 Trajectory/Prognosis 183 Manifestations 183 Management 183 Pharmacologic 183 Physical 184 Nutritional 184 The Suffering of Dyspnea: Palliative Care 184 References 185 15 Gastrointestinal Conditions 186 Shea Cox, DVM, CHPV, CVPP and Christie Cornelius, DVM, CHPV Inflammatory Bowel Disease 186 Description of Disease 186 Disease Trajectory 186 Clinical Manifestations of Disease 186 Palliative Management 186 Medical Support 186 Immunosuppressive Therapy 186 Antibiotic Therapy 187 Additional Support Therapy 187 Nutritional Support 188 Fecal Microbial Transplantation (FMT): The Ultimate Probiotic 188 Pancreatitis 188 Description of Disease 188 Disease Trajectory 188 Clinical Manifestations of Disease 189 Palliative Management 189 Medical Support 189 Analgesia 189 Antiemetics 189 Antibacterials 189 Immunosuppressants 189 Subcutaneous Fluid Therapy 189 Nutritional Support 189 Cholangitis/Cholangiohepatitis Syndrome 190 Description of Disease 190 Disease Trajectory 190 Clinical Manifestations of Disease 190 Palliative Management 190 Medical Support 190 Antimicrobial Therapy 190 Immunosuppressive Therapy 190 Analgesia 191 Antiemetics 191 Support Therapy 191 Subcutaneous Fluid Therapy 191 Nutritional Support 191 Conclusion 191 References 191 16 Musculoskeletal Disorders 193 Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, MSTCVM Osteoarthritis 193 Description 193 Trajectory/Prognosis 194 Manifestations 194 Management 195 Cranial Cruciate Ligament Pathology 197 Description 197 Trajectory/Prognosis 197 Manifestations 197 Management 197 Medical Management 198 Surgical Management 198 Strains, Sprains, and Myofascial Pain 199 Description 199 Trajectory/Prognosis 199 Manifestations 199 Management 199 Coxofemoral Luxation 200 Description 200 Trajectory/Prognosis 200 Manifestations 200 Management 200 Fractures 201 Description 201 Trajectory/Prognosis 201 Manifestations 201 Management 201 Conclusion 201 References 202 17 Nervous System Disease 204 Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, MSTCVM Intervertebral Disc Disease 204 Description 204 Trajectory/Prognosis 205 Manifestations 205 Management 206 Cervical Spondylomyelopathy 207 Description 207 Trajectory/Prognosis 208 Manifestations 208 Management 208 Fibrocartilagenous Embolic Myelopathy 208 Description 208 Trajectory/Prognosis 209 Manifestations 209 Management 209 Vestibular Disorders 209 Description 209 Trajectory/Prognosis 210 Manifestations 210 Management 210 Laryngeal Paralysis/Geriatric Onset Laryngeal Paralysis Polyneuropathy 211 Description 211 Trajectory/Prognosis 211 Manifestations 211 Management 211 Degenerative Myelopathy 212 Description 212 Trajectory/Prognosis 213 Manifestations 213 Management 213 Disorders of Micturition/Urination 214 Description 214 Trajectory/Prognosis 214 Manifestations 214 Management 214 Bladder Is Difficult or Cannot Be Expressed 215 Bladder Can Be Expressed with Effort 215 Straining to Urinate with Spurts of Urine Produced 215 Bladder Easily Expressed with Continuous Leakage 216 Urine Leakage when Urine Accumulates 216 Ancillary Therapies for Micturition Disorders 216 Conclusion 216 References 216 18 Cognitive Dysfunction 219 Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, MSTCVM Description 219 Trajectory/Prognosis 220 Manifestations 220 Management 221 Client Education and Prevention 221 Behavior Modification and Environmental Enhancement 221 Diet Modification 222 Supplements 222 Alternative Care 223 Pharmaceutical Interventions 223 Conclusion 224 References 225 19 Pharmacology Interventions for Symptom Management 227 Shea Cox, DVM, CHPV, CVPP Introduction 227 Pain 227 Clinical Signs of Pain 227 Behavioral Indicators of Pain 227 Pharmacology for Pain Management 228 Nonsteroidal Anti- Inflammatory Drugs 228 Glucocorticoids 229 Acetaminophen 229 Opioids 229 Tricyclic Antidepressants 231 Serotonin- Norepinephrine Reuptake Inhibitors 232 Anticonvulsants 232 N- methyl- d- aspartate Receptor Antagonists 232 Monoclonal antibodies 233 Pharmacologic Protocols 233 Assessing Response to Treatment 234 Anxiety 234 Dysphoria 236 Weakness or Fatigue 237 Respiratory Symptoms 237 Dyspnea 237 Cough 239 Nausea and Vomiting 239 Anorexia and Cachexia 240 Dehydration 241 Constipation 241 Oral Health 242 Ulcers 242 Dry Mouth (Xerostomia) 242 Conclusion 242 References 242 20 Physical Medicine and Rehabilitation for Hospice and Palliative Care Patients 245 Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, MSTCVM Physical Medicine vs. Physical Rehabilitation 245 Considerations for Physical Medicine with Hospice and Palliative Care Patients 245 Assistive Devices: Priority in Hospice Care 247 Slings and Harnesses 247 Straps and Bands 248 Protective Footwear 248 Support of Joints: Orthotic Devices 249 Support for Paralysis/Pararesis: Carts and Drag Bags 250 Four Simple but Important Manual Therapies and Therapeutic Exercises 250 Range of Motion 250 Assisted Standing and Walking 251 Proprioceptive and Balance Techniques 251 Massage and/or Tui-na 252 The Role of Acupuncture for Hospice and Palliative Care Patients 252 Innovative and Noninvasive Techniques 254 Kinesiology Taping 254 Extracorporeal Magnetotransduction Therapy: EMTT 257 Extracorporeal Shockwave Therapy 257 Targeted Pulsed Electromagnetic Field Therapy 258 Other Therapeutic Modalities for Hospice and Palliative Care Patients 259 Thermal Modalities 259 Photobiomodulation Therapy (also known as Laser Therapy) 260 Pulsed Signal Therapy 261 Electrotherapy 261 Therapeutic Ultrasound 262 Manual Therapy/Medical Manipulation/Chiropractic Care 262 Conclusion 263 References 263 21 Integrative Medicine in Animal Hospice and Palliative Care 265 Kristina August, DVM, GDVWHM, CHPV Terms 265 Going Mainstream 266 Safety and Adverse Reactions 267 Healing Philosophies 268 Nutritional Supplements 269 Herbal Medicine 269 Essential Oils 271 Other Therapies 272 Ensuring Quality of Life 273 Reliable Choices and Client Education 273 Conclusion 274 Educational Opportunities 274 References 274 22 Nursing Care for Seriously III Animals: Art and Techniques 278 Shea Cox, DVM, CHPV, CVPP and Mary Ellen Goldberg, CVT, LVT, SRA-retired, CCRVN, CVPP, VTS-lab animal-retired, VTS-Physical Rehabilitation-retired, VTS-anesthesia/analgesia-Honorary Introduction 278 Nurses’ Medical Roles 279 Intake 279 Planning of Care 279 Ongoing Monitoring and Assessments 279 Frequency of Assessments 279 Parameters of Assessments 279 Assessment of Pain 280 Pain Scales 280 Assessment of Other Signs of Discomfort 282 Assessment for Dehydration 282 Assessment of Medication Administration 282 Assessment of Mobility 282 Assessment of Mental and Emotional Status 283 Delivery of Care: Nursing Care Considerations 284 Comfort for the Patient 284 Oral and Ocular Comfort 284 Nutrition 286 Hydration 287 Treating Fluid Deficit (Dehydration) 287 Maintenance Fluids Administration 288 Calculating Fluid Deficit 288 Hygiene 288 Bedding 288 Environment 289 Mobility 289 Range of Motion (ROM) 289 Transitions 290 Standby Assisted Standing 290 Weight Shifting Exercises 290 Assisted Standing Exercises 290 Aids for Assisted Standing 290 Mobility Carts 290 Nursing Care for Recumbent Patients 290 Urination 291 Defecation 291 Respiration 291 Skin Care 292 Mobilizing the Recumbent Patient 292 Nurses as Advocates and Educators 292 Nurses’ Role as Advocates for Patient and for the Caregiver 293 Nurses’ Role as Educators 293 Awareness of Signs of Pain 294 Hygiene and Safety 294 Death and Dying 295 Conclusion 295 References 296 Further Reading 298 23 Comfort Care During Active Dying 299 Gail Pope and Amir Shanan, DVM Natural Death and Euthanasia 299 Goals of Caring for the Dying Patient 301 Advance Preparation and Education of Caregivers and Hospice Team 301 Desirable Environment of Care 302 Prognostication 303 Changes During Early and Late Stages of Active Dying 303 Available Information 303 Changes During Early Stages of Active Dying 303 Physical Changes 303 Behavioral Changes 304 Indications of Pain 304 Changes During Late Stages of Active Dying 305 Behavior, Sleeping Pattern, Responsiveness 305 Respiration 305 Eyes, Mucus Membranes, Jaw, and Extremities 306 Muscle Twitching, Stretching, and the Agonal Position 306 Odor 306 Summary 306 At the Time of Death 306 The Different Types of Active Death 308 Managing Clinical Signs During Active Dying 309 Management of Pain 309 Management of Anxiety and Agitation 310 Fatigue and Weakness 310 Loss of Ability to Swallow 311 Respiration 311 Cardiac Dysfunction and Renal Failure 311 Diminished Skin Vitality 311 Mucosal and Conjunctival Care 312 Incontinence 312 Administration of Medications, Fluids, and Food 312 Administration of Fluids 313 Administration of Food 314 Administration of Medications 314 Summary 315 References 315 24 Euthanasia in Animal End- of- Life Care 318 Kathleen Cooney, DVM, CHPV, DACAW Decision- Making for the Animal Hospice Patient 318 Advance Preparation and Education of the Professional Team 319 Advance Preparation and Education of Caregivers and Family 321 Euthanasia Setting: Desirable Environment of Care 323 Euthanasia Techniques and Criteria 324 Intravenous Injection 325 Intracardiac Injection 325 Intraperitoneal Injection 327 Intrahepatic Injection 328 Intrarenal Injections 329 Variability and Unpredictability 330 References 331 Part III Caregiver Needs: Providing Support 333 25 Caregivers’ Emotional Burden: Understanding, Acknowledging, and Addressing Caregivers’ Emotional Burden 335 Amir Shanan, DVM Caregiving Experience 336 The Mental Health Impact of Caregiving 339 Supporting caregivers’ Emotional Needs 340 The Role of a Licensed Mental Health Professional 343 Qualified Mental Health Professionals 345 Summary 346 References 347 26 Caregiver Burden in the Companion Animal Owner 349 Mary Beth Spitznagel, PhD and Mark D. Carlson, DVM What Is Caregiver Burden? 349 A Word About Research Data, the Terminology Used, and this Article’s Audience 349 Caregiver Burden Is Present in Owners of Seriously Ill Companion Animals 350 How Caregiver Burden Differs from Other Client Experiences in this Context 350 How Does Caregiver Burden Affect the Veterinary Client? 351 Impact of Caregiver Burden on the Client 351 Impact of Caregiver Burden on the Patient 352 Research- Based Suggestions for Interacting with the Burdened Owner 352 Understand the Owner’s Perspective 352 Collaborate on the Care Approach 353 Lighten the Load 353 One Size Does Not Fit All: Toward Individualized Client Interactions 354 Interacting with the Distressed Client 354 Interacting with the Resilient Client 355 Interacting with the Non- Distressed Client 355 Interacting with the “Other Influences” Client 355 More than Compassion Fatigue: When Client Burden Transfers to the Clinician 355 The Burden Transfer DANCE 356 Conclusions 357 References 357 27 Addressing Spiritual Needs of Caregivers 360 Carol Rowehl, LVT, MAR, STM Spiritual Needs of Caregivers 361 Spiritual Distress 362 Taking a Spiritual History 363 When to Call in the Experts (and Who Are the Experts?) 364 Spiritual Questions Unique to Veterinary Practice and Hospice and Palliative Care 366 Including a Chaplain on the Interdisciplinary Veterinary/Hospice Team 367 Resources 370 References 371 28 Factors Contributing to the Decision to Euthanize Pet Dogs and Cats 374 Nathaniel Cook, DVM, CVA, CVFT, CTPEP and Beth Marchitelli, DVM, MS Introduction 374 Pet Factors: Symptoms and Clinical Signs that Affect Quality of Life 374 Appetite and Weight Loss 375 Appetite 375 Weight Loss 377 Elimination Disorders 377 Impaired Mobility 379 Sensory and Cognitive Decline 380 Dyspnea and Respiratory Compromise 381 Perception of Pain 382 Pet Factors: Severe Illness Diagnosis 382 Cancer 382 Organ Failure: Congestive Heart Failure 383 Endocrine Disorders: Diabetes Mellitus 384 Pet Owner Factors: Psychosocial Factors of Caregiving 384 Conclusion 385 References 385 29 Supporting Other Needs 389 Shea Cox, DVM, CHPV, CVPP and Mary Ellen Goldberg, CVT, LVT, SRA-retired, CCRVN, CVPP VTS-lab animal-retired, VTS-Physical Rehabilitation-retired, VTS-anesthesia/analgesia-Honorary Caring for the Caregiver: Addressing Emotional and Physical Needs 389 Maintaining Self- Care 390 Maintain Personal Nutrition and Sleep 390 Engage in Exercise 390 Make Time for Relaxation 390 Time Considerations of Hospice Care 391 Managing Time Commitments of Care 391 Tips for Balancing Caregiving with Ongoing Responsibilities 391 Understanding the Physical Labor of Care 391 Utilizing Proper Body Mechanics During Delivery of Care 392 Environmental Considerations of Hospice Care 393 Assessment of the Physical Space 393 Household and Environmental Modifications 393 Financial Considerations of Hospice Care 393 Cost of Medications 394 Cost of Diagnostics 394 Cost of Other Healthcare Providers 394 Cost of Environmental Modifications 394 Cost of End- of- Life Care 394 Helping to Defer Costs of Hospice Care 395 Pet Health Insurance 395 Equipment Rental, Recycling, and Reduced Cost Programs 395 Creating a Memorial Fund 395 Creating a Donation Bank 395 References 396 Further Reading 396 30 Aftercare 398 Coleen A. Ellis, CT, CPLP Hospice Options and Accompanying Rituals 398 Emotional Support: Honoring the Journey 401 Assisting Children, Other Pets, and Family Members in Their Journey 402 After- Death Care Options 402 Summary 406 References 406 Index 407

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Details

  • NCID
    BC18475403
  • ISBN
    • 9781119808787
  • Country Code
    us
  • Title Language Code
    eng
  • Text Language Code
    eng
  • Place of Publication
    Hoboken, NJ
  • Pages/Volumes
    xxiv, 424 p.
  • Size
    26 cm
  • Classification
  • Subject Headings
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