Veterinary palliative medicine is a form of care in which a decision has been made to stop attempts to cure a terminal or life-limiting illness. Some diseases that we treat in dogs are managed over the long term without any hope for a cure. These include diabetes, chronic kidney disease, and congestive heart disease. Managing these and other chronic diseases is not the same as palliative care.
Palliative medicine is care that is delivered as a dog approaches the end of life. The most common circumstances that precede palliative care include:
- The diagnosis or progression of a life-limiting illness.
- The decision not to pursue curative therapy.
- The progression of disease symptoms, so that they interfere with the activities of daily living.
My dog has very advanced cancer, and the hope for a cure is remote. What kind of palliative care is appropriate?
Incurable cancer provides an example for explaining the principles and practices of veterinary palliative medicine. Palliative care in the face of life-limiting cancer is as individual as the patient and type of cancer.
The first step in creating a palliative care plan for your dog is to meet with your veterinarian to discuss the expected course of the disease and how it will affect your dog's quality of life. This visit also gives you a chance to talk about your dog's daily activities. This is a crucial first step because it allows everyone to participate in the palliative care planning. The dog's lifestyle is an important consideration for defining good quality of life versus poor or unacceptable quality of life (see handout "Quality of Life at the End of Life for Your Dog").
"An essential part of establishing goals of palliative therapy is understanding
the expected course of the life-limiting disease."
Once a dog's activities of daily living have been identified, it is important to define family beliefs, the family's needs as care unfolds, and the goals for the dog as death approaches. An essential part of establishing goals of palliative therapy is understanding the expected course of the life-limiting disease - in this case, cancer. Knowledge about disease allows for the development of a personalized palliative care plan.
How can palliative care help make my dog with life-limiting disease more comfortable?
Pain management is the most important part of palliative care. Pain is best managed using multiple therapies together, both pharmacologic (medications) and nonpharmacologic, to achieve maximum comfort.
Several classes of medication, as well as nutritional supplements (nutraceuticals), can be used together to combat pain. Your veterinarian may also suggest one or more nonpharmacologic therapies to address musculoskeletal pain:
- Medical acupuncture can change your dog’s perception of pain by sending signals to the brain and nervous system. Acupuncture can also release painful trigger points in muscles and reduce abnormal nervous system activity.
- Massage can be performed by a trained provider and massage techniques can also be taught for use at home. Most dogs find massage comforting.
- Therapeutic laser can modulate the nervous system to reduce pain. Laser also increases circulation and decreases inflammation.
- Chiropractic adjustment, used to restore movement in the skeleton where restrictions have occurred, may help a palliative care patient move more normally.
- Physical therapy provides strategies for maintaining mobility and preventing and managing pain.
How can I make my home more comfortable for my dog who is receiving palliative care?
Palliative care includes modifying the home environment to maximize mobility and prevent injury to the dog, whose balance and ability to move normally may be compromised. Some simple modifications include:
- Adding non-skid floor surfaces, which make moving around the house easier. There are several creative ways to create non-skid floors, including using area rugs or the spongy, interlocking floor tiles found in children's play areas and gyms.
- Raising food and water dishes to just above elbow height. This change allows a dog to eat and drink with the spine in a neutral position, minimizing back pain. If the dog is minimally mobile, you can place food and water bowls in front of them wherever they are comfortable resting.
- Blocking access to stairs or making sure the dog is supervised when navigating stairs. You can use a sling or vest to assist a dog if carrying him is not an option.
- Using soft and easily cleaned bedding to make them as comfortable as possible.
- Providing ramps or other assistive devices to access the bed or a favorite piece of furniture.
- Creating places to “hang out”. Making comfortable spaces, close to family members, helps your dog remain engaged with the family they love.
Palliative care involves controlling pain, maintaining mobility, and adapting the environment to keep your dog engaged in family activities. Your veterinary team will partner with you to create the most appropriate palliative care plan for your dog.