Animal Hospice and Palliative Medicine for the House Call Veterinarian

1st Edition - October 20, 2022
Author: Lynn Hendrix
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 5 6 7 9 8 - 5
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 5 6 7 9 9 - 2

Gain the understanding you need to provide compassionate, end-of-life pet care. Animal Hospice and Palliative Medicine for the House Call Veterinarian provides an all-in-on… Read more

Animal Hospice and Palliative Medicine for the House Call Veterinarian

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Gain the understanding you need to provide compassionate, end-of-life pet care. Animal Hospice and Palliative Medicine for the House Call Veterinarian provides an all-in-one guide to the skills and challenges related to this growing area of veterinary care. From setting up your business and performing your first in-home consultation to managing pain, performing in-home euthanasia, and providing grief support to the family, this book walks you through each step of care. Written by Dr. Lynn Hendrix, a leading expert and researcher in veterinary palliative medicine, this practical resource shows how to improve the quality of care for pets in the final stages of life.

Cover image
Title page
Table of Contents
Copyright
Contributors
Preface
Chapter 1. Introduction to animal hospice
Paradigm shift
Increasing awareness
Founding organizations
Similarities to human hospice and differences
Evidence-based medicine
Conclusion
Chapter 2. Veterinary Palliative Medicine changes the paradigm
Highlights
Introduction to palliative medicine
Veterinary palliative medicine versus animal hospice
Goals of veterinary palliative medicine and hospice
Challenges faced in starting veterinary palliative medicine or animal hospice
Myths and other FAQs
Conclusion
Chapter 3. House call business basics
Setting up a housecall practice
Marketing for hospice, palliative medicine, and in-home euthanasia services
Conclusion
Chapter 4. Your first appointment
Prior to the visit
Setting up the appointment
First meeting in the home
Legal
Informational white sheets
The exam
Distress versus suffering
Quality-of-life scales
The HHHHHMM scale
Brambell's Five Freedoms
JOURNEY's quality-of-life scale
JOURNEYS quality of life scale for pets considers the following
Lap of Love quality-of-life scale
Animal advanced directives
Prescribing medication in the home setting
Planning for death and body care
What to do in a crisis
Wrapping up the consultation
Making follow-up visits
One last thing …
Calendar your life
Conclusion
Chapter 5. Palliative symptom and disease management
Anxiety
Ascites
Bleeding
Head and neck bleeding
Oral bleeding
Bleeding dermal masses
Bleeding internal organs
Hemoptysis
Disseminated intravascular coagulopathy and other coagulopathies
Breathlessness
General symptoms that may occur with breathlessness
Specific diseases that may cause breathlessness in end-of-life patients
End-stage pulmonary disease
Pulmonary neoplasia
COPD
Late-stage pneumonia
Cachexia and other muscle loss in the end-of-life patient
Identifying factors involved in cachexia
Carcinomatosis
Chronic kidney disease, end-stage
Constipation
Delirium
Dementia
Etiology/DDX
Diarrhea
Dysphagia
Dysrexia
Fever
Frailty
Hydration/nutrition for the late-stage patient
Hypercalcemia
Hypertension
Liver cancer and other late-stage liver diseases
Metastasis
Nausea/vomiting
Neuromuscular disease
Laryngeal paralysis/Geriatric Onset Laryngeal Paralysis and Polyneuropathy (GOLPP)
Musculoskeletal issues
Osteosarcoma
Nonmedical therapies
Oral care for diseases of the head and neck
Pancreatic disease, late-stage
Pancreatic cancer
Insulinoma
Glucagonoma
Gastrinoma
Seizures
Sleep/wake disturbances
Skin care, end-of-life
Interventional therapies
Integrative care
Conclusion
Chapter 6. Chronic pain management in the home setting
Recognizing chronic pain
The physiology of pain
Types of pain
Summary of pain terminology
Evaluating chronic and cancer pain in the late-stage patient
Dog-specific chronic pain behavior
Cat-specific chronic pain behavior
Common pain-related behavior for dogs or cats
Assessing chronic pain
Validated chronic pain scales
Chronic pain in specific diseases
Organ failure and other comorbidities
Treatment: Pharmaceuticals for chronic pain in veterinary patients
Non-steroidal anti-inflammatory drugs (NSAIDs)
Recommended NSAID dosages and indications
Cox-1 inhibitors
Cox-2 selective inhibitors
Cox-3/Cox1-V1 inhibition
PGE-4 receptor antagonist
Steroids
Gabapentinoids
Antidepressants
Cerenia® (maropitant)
Local anesthetics
Medication to treat acute pain in the home setting
Tramadol
Non-pharmaceutical pain management
Palliative radiation
Weight loss therapy
Physical therapy, rehabilitation
Nutraceuticals
Herbal therapies
Cannabis
Acupuncture
Low-Level Therapeutic Laser
Heat/Cold therapy
Music
Targeted pulsed electromagnetic field therapy
Developing a crisis kit
Chapter 7. Physical support
Supporting mobility and quality of life
Benefits of improving mobility
Dealing with mobility complications in chronic and life-limiting disease
Multimodal analgesia
A personalized plan for mobility
Managing the environment
Assistive devices
Toe grips and pad treatments
Business aspects of wheelchair/cart sales and rentals
Other mobility aids
Orthotics and prosthetics
Splints
Booties and socks
Physical therapy
Tools utilized by veterinary physical therapists/rehabilitators
TENS unit
Assisi loop
Chiropractic
Conclusion
Chapter 8. Creating your interdisciplinary team
The ideal team
Additional skills needed by veterinary technicians in veterinary hospice and palliative care
Communication
Analytical skills
Technical patient skills
Caregiver/client skills
Body care of deceased animals
Hospice/Palliative additional team skills
Knowledge of animal hospice ethics
Other team members
Chapter 9. Supporting grief
A brief overview of mental health professionals
Common understanding of grief
Stages of expected grief
Trajectories of grief
Postdeath expected grief
“Atypical” grief
Complicated grief
Clinical signs of complicated grief
How complicated grief differs from “Typical” grief
Disenfranchised grief
Delayed grief
Traumatic death
Traumatic grief
Suicidal ideation
Suicide risk factors
Health factors
Environmental factors
Historical factors
Talking to children about end-of-life issues
Four cognitive stages for child development: infancy through adolescence
Infants and toddlers (birth to 2 years)
Preschoolers (2–5 years)
School-age (6–11 years)
Tweens and teens (12–18 years)
At-home discussions with children
Memorializing
Adult support: finding mental health professionals to help you help clients
Adult and youth support books
Grief in animals
Chapter 10. Supporting a palliated death⋆
Changing our definitions
Death is the natural conclusion of life
Utilizing veterinary palliative medicine at the end of life
The physiology of death
Clinical signs of impending death
Pathophysiology of death
Cardiopulmonary
Neurologic changes
Altered oxygen and carbon dioxide levels
Altered blood flow
Increased intracranial pressure
Delirium
Palliated death
Palliative sedation
Holding vigil
Planning for imminent death
Medications to have on hand for imminent death
Post-palliated death
Postmortem changes (0min–2h)
Postmortem changes (30 min–36 h)
Unusual postmortem phenomena
Postmortem (within a few minutes to days, months)
Conclusion
Checklist for the veterinarian caring for a palliative-supported patient (regardless of the death)
Chapter 11. Providing a gentle death-Euthanasia
The client's experience
The animal's experience
Routes for medication
α-2 agonists
Seratonin reuptake inhibitors
Injectable medications
Opioids
α-2 agonists
Benzodiazepines
Difficult euthanasias
Additional tips and challenging situations to prepare for
Conclusion
Chapter 12. Respectful aftercare of the beloved pet
Types of cremation
Rituals around body care
Herbs/incense
Crystals
Personal items of animal
Religious and cultural traditions
Catholic
Judaism
Muslim
Hinduism
Buddhist
Pagan
Chapter 13. Dealing with compassion fatigue, burnout, and impostor syndrome
The difference between compassion fatigue and burnout
What can you do to change your path?
Impostor syndrome
Conclusion
Chapter 14. Personal safety and difficult home visits
Personal safety
Phone contact
An angry call
An example of a call that sounded dangerous
Drug-seeking phone calls
Arriving at the house
Physical abuse
Angry and emotionally abusive clients
Case example
Weapons in the home
When families disagree
Emotional and verbal abuse
Complicated grief
What can you do for those who you are concerned might be considering suicide?
A word on self-defense
Start creating plans
Cancellations
Firing clients
Firing a client letter
The euthanasia that has gone poorly
Conclusion
Chapter 15. Expanding access to palliative medicine education and organization
Hospice or palliative medicine?
Current organizations
IAAHPC
IVAPM
The future of veterinary palliative medicine organizations
WVPMO
Local organizations around the world
The Australian Veterinary Palliative Care Advisory Council
Other conferences
Online education
VIN folder
Facebook group—Veterinarian Palliative Medicine Group
Conclusion
Chapter 16. Redefining veterinary medicine: The future of veterinary palliative medicine and animal hospice
Where do we need to go?
Getting veterinary palliative care to more people and their pets
Certification to specialization
What more could we do?
Involving more veterinary technicians and mental health
Research
Building other interdisciplinary organizations
Technology for veterinary palliative medicine
Integration of early palliative care into practice
Appendix
Index